肺保护性通气对严重胸外伤致急性呼吸窘迫综合征疗效的影响研究

Effect of Ventilation with Pulmonary Protective Ventilation for Acute Respiratory Distress Syndrome in Severe Thoracic Trauma

目的探讨小潮气量(LTV)加呼气末正压(PEEP)机械通气(MV)治疗严重胸外伤致急性呼吸窘迫综合征(ARDS)的疗效。方法以28例常规潮气量(8～12ml/kg)MV为对照组,30例小潮气量(5～7ml/kg)加用PEEP的MV模式为观察组,比较两组血气,RR、HR、MAP、CVP、呼吸机所致肺损伤(VILI)、多脏器功能不全(MODS)发生率及ARDS病死率。结果两组PaO2差异无显著性意义;观察组PaCO2高于对照组;观察组出现6例VILI、4例MODS及死亡3例,对照组13例VILI、7例MODS、死亡5例。结论在ARDS治疗中采用小潮气量加PEEP及允许范围内高碳酸血症(PHC)的肺保护性通气策略,可明显改善缺氧,减少VILI发生,从而降低病死率。

Objective To compare the effect of mechanical ventilation（MV） with lower tidal volumes（LTV） plus pos-itive end-expiratory pressure（PEEP） versus conventional tidal volumes（CTV） in the treatment of post-traumaticacute respiratory distress syndrome（ARDS）.Methods From Nov.2004to Dec.2010,28 cases of post-traumatic ARDS were treated with conventional MV using 8～12ml/kg of tidal volume（control group）;From Jan.2007 to Oct.2010,30cases of post-traumatic ARDS were treated with low tidal volume（5～7ml/kg） plus PEEP MV（observation group）.A comparison was made upon blood gas,RR,HR,MAP,CVP,incidence of ventilation-induced lung injury（VILI）,incidence of multiple organ dysfunction syndrome（MODS） as well as mortality of ARDS.Results There was no statistically significant difference in PaO2and hemodynamic indexes between two groups,while PaCO2in observation group was higher than in control group.while in observation group,there were 6cases of VILI,4cases of MODS and 3cases of death,while in control group,there were 13 cases of VILI,7cases of MODS and 5cases of death.Conclusion Protective MV with LTV plus PEEP and permissive hypercapnia（PHC） can attain the same effect of oxygen saturation as conventional MV and reduce the VILI and the mortality of ARDS.