保护性通气策略治疗ARDS的临床应用

Application of Protective Ventilation Strategy in Treatment of Acute Respiratory Distress Syndrome

目的比较传统通气策略和肺保护性通气策略(LPSV)应用于急性呼吸窘迫综合征(ARDS)机械通气治疗的效果和相关并发症的发生情况,评价LPSV的临床应用价值。方法将不同原因引起的符合ARDS诊断标准并符合上机指征的54例患儿按随机数字表法分为2组,每组27例。A组用传统通气策略,B组运用LPSV。对2组呼吸机设置、血分析结果、肺氧合指数、呼吸机相关性并发症、呼吸机运用时间、住院时间的数据进行比较分析。结果 B组患儿的气道峰压(PIP)、潮气量(VT)均低于A组(P<0.01);B组呼气末正压(PEEP)高于A组(P<0.01)。B组动脉血二氧化碳分压(PaCO2)高于A组(P<0.01),2组动脉血氧分压(PaO2)差异无统计学意义(P>0.05)。氧合指数(OI)B组高于A组(P<0.01)。B组呼吸机相关性肺损伤、气胸的发生率低于A组(P<0.05),2组病死率比较差异无统计学意义(P>0.05)。B组的上机时间及住院时间均短于A组(P<0.05)。结论采用LPSV治疗ARDS可改善肺部气体氧合,维持适当血氧分压,减少并发症,缩短患儿的上机时间和住院时间,是一种相对安全有效的通气策略。

Objective To compare the effects of lung protective ventilation strategy（LPSV） and traditional ventilation strategy on acute respiratory distress syndrome（ARDS）,ant to evaluate the clinical value of LPSV.Methods A total of 54 children with ARDS were randomly assigned to a conventional ventilation strategy（n=27,group A）or a protective ventilation strategy（n=27,group B）.The ventilator settings,blood gas analysis results,oxygenation indexes,complications,duration of ventilator use and length of hospitalization were compared between the two groups.Results Compared with group A,LPSV significantly decreased peak airway pressure,tidal volume,incidence of pneumothorax and lung injury,duration of ventilator use and length of hospitalization,but obviously increased PaCO2 and oxygenation indexes（P〈0.01 or P〈0.05）.There were no significant differences in PaO2 and case-fatality rate between group A and group B（P〉0.05）.Conclusion The treatment with LPSV is relatively safe and effective for ARDS,and can improve lung oxygenation,maintain adequate PaO2,reduce ventilator-associated complications and shorten the duration of ventilator use and length of hospitalization.