两种机械通气模式对创伤性连枷胸并肺挫伤的应用比较

A Comparative Study of Two Different Ventilations in Patients with Flail Chest caused by Blunt Thoracic Trauma

目的比较创伤性连枷胸并肺挫伤治疗经面罩无创持续气道正压通气(CPAP)通气模式和经气管插管同步间歇指令通气(SIMV)+呼气末正压通气(PEEP)的通气模式临床效果。方法 50例肺挫伤患者随机分为两组:FM组(25例)采用经面罩无创CPAP模式机械通气;ETI组(25例)采用气管插管SIMV+PEEP模式机械通气。观察和比较两组的主要并发症、动脉血氧分压(PaO2)、ICU住院时间及ICU期内的存活率。结果 FM组有3例继发肺感染,ETI组有13例继发肺感染,两组比较有显著性差异(P<0.01)。ETI组的PaO2在开始第1天较FM组明显增高,但之后无明显差异,两组入住ICU时间无明显差异(P>0.05)。FM组存活25例,ETI组存活18例,两组比较有显著性差异(P<0.05)。结论经面罩无创CPAP通气治疗创伤性连枷胸并肺挫伤能有效减少继发性肺感染的发生,降低病死率,值得临床推广。

Objective To evaluate non-invasive positive pressure ventilation delivered via a face mask and intermittent positive pressure ventilation with endotracheal intubation（ETI） in patients with flail chest caused by blunt thoracic trauma.Method 50 patients with blunt thoracic trauma who required mechanical ventilation were divided into two groups in random.The FM group（n=25） received continuous positive airway pressure（CPAP） given via a facemask;the ET group（n=25） received synchronous intermittent ventilation（SIMV） and positive end-expiratory pressure（PEEP） with ETI.Major complications,arterial blood gas levels,length of intensive care unit（ICU） stay and ICU survival rate were recorded.Results Nosocomial infection was diagnosed in 13 of 25 patients in the ET group,but only in 3 of 25 in the CPAP group（P 0.01）.Mean PaO2 was significantly higher in the ET group in the first day but were no significant differences after the first day between two groups.There were no significant differences in length of ICU stay between two groups.25 CPAP patients survived,but only 18 of 25 intubated patients survived（P0.05）.Conclusion Noninvasive CPAP via a facemask led to lower mortality and a lower nosocomial infection rate.The study supports the application of CPAP at least as a first line of treatment for flail chest caused by blunt thoracic trauma.