持续高水平PEEP治疗肺内源性ARDS的临床观察

Continuous higher positive end-expiratory pressures in patients with the acute respiratory distress syndrome of pulmonary endogenous

目的探讨持续高水平PEEP治疗肺内源性ARDS的价值。方法前瞻性分析2003年1月-2007年12月21例于广东省佛山市顺德区第一人民医院等医院住院进行有创机械通气治疗的ARDS患者的临床资料。根据其PEEP是否〉12cmH2O,分为治疗组及对照组,采用χ2检验对两组患者的死亡率进行比较,采用重复测量数据的方差分析比较两种治疗方法对24 h内氧合指数、血压及心率等指标的影响变化。使用Mann-Whitney检验比较两组患者24 h血管活性药物的用量。结果两组患者的死亡率无显著性差异（P〉0.05）,两种不同治疗手段对肺内源性ARDS患者的氧合指数的影响无统计学显著性差异（P〉0.05）,治疗组患者在使用较大量的血管活性药物情况下两种不同治疗手段对肺内源性ARDS患者的血压、心率影响无统计学显著性差异（P〉0.05）,但两组患者在不同时间点的氧合指数、舒张血压等指标有统计学显著性差异（P〈0.05）。结论肺内源性ARDS患者使用持续高水平PEEP治疗并不可取。

Objective to investigate the effect on continuous higher positive end-expiratory pressures in patients with the acute respiratory distress syndrome of pulmonary endogenous.Methods Prospective study was performed among 21 patients with ARDS in the first people Hospital of shunde,the people hospital of guoming and people＇s hospital of xiaolan from January 2003 to December 2007.The patients were divided into the higher PEEP group and the lower PEEP group.The Mortality as the parameters were analyzed by Chi-square test.The amount of dopamine were analyzed by Mann-Whitney test.The effect on arterial blood gas sample,BP and HR between two different treatment were analyzed by repeated measures.Results The Mortality has no Significant difference between two groups（P〈0.05）,the effect on arterial blood gas sample,BP and HR between two groups has no Significant difference too（P〉0.05）,but The amount of dopamine had Significant difference between two groups（P〈0.05）,the OI and DBP had Significant difference in different time（P〈0.05）.Conclusion The continuous higher positive end-expiratory pressures is not good treatment for the patient with ARDS p.