甲型H1N1流感危重症患者机械通气治疗后发生气压伤的相关危险因素分析

Analysis on the risk factors of pulmonary barotrauma during mechanical ventilation treatment in patients with severe novel A H1N1 influenza

目的:分析甲型H1N1流感危重症患者在机械通气时发生气压伤的危险因素。方法:对2009年11月-2010年2月山东省胸科医院ICU收治的15例行机械通气的甲型H1N1流感危重症患者按有无发生气压伤分成两组,对患者性别、年龄、28 d在院病死率、急性生理学和慢性健康状况评分、肺损伤评分、氧合指数及呼吸支持时肺部静态顺应性、呼吸频率、呼气末正压、最大吸气压力、潮气量和氧浓度指标进行回顾分析。结果:气压伤组患者的肺损伤评分、吸入氧浓度明显高于无气压伤组患者(P=0.001,P=0.008),肺部静态顺应性(Cstat)要明显低于未出现气压伤的患者(P=0.024),两组之间差异具有统计学意义。两组患者的年龄、性别、APACHEⅡ评分、呼气末正压、最大吸气压力、潮气量和呼吸频率之间差异无统计学意义(P均>0.05)。结论:甲型H1N1流感病毒对肺组织的严重损害及其导致的肺静态顺应性下降可能是导致危重症患者机械通气时发生气压伤的重要因素。

Objective.. To analyae the risk factors of the barotrauma in patients with severe novel A H1N1 influenza treated with mechanical ventilation. Methods： Fifteen severe novel A H1N1 influenza patients who were consecutively admitted to intensive care unit （ICU） of the Shandong Provincial Chest Hospital from November 2009 to Feburary 2010 and treated with mechanical ventilation were divided into two groups., barotrauma group and nonbarotrauma group. Sex, age, mortality in 28 days, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） scores, modified lung injury scores, oxygen index,and static lung compliance （Cstat）, respiratory rate （RR）, positive end expiratory pressure （PEEP）, peak inspiratory pressure （PIP）, tidal volume （TV） and fractional concentration of respiratory oxygen （FiO2） during mechanical ventilation were retrospectively analyzed. Results：Compared with non-barotrauma group, lung injury scores and FiO2 were higher （P= 0. 001, P=0. 008）, and Cstat was lower （P=0. 024） in barotrauma group. Between two groups, there were no differences in sex, age, A- PACHE 11 , PEEP, PIP, VT, and RR in mechanical ventilation phases （P〉0.05）. Conclusion：When lung injury is caused by A/H1N1 influenza virus, a decline of Cstat is the risk factor of the barotrauma to the severe novel H1N1 influenza patients treated with mechanical ventilation.