肺保护性通气策略在急性百草枯中毒致肺损伤中的临床应用

The clinical application of lung-protective ventilation strategy in lung injury induced by acute paraquat poisoning

目的探讨肺保护性通气策略(LPVS)在急性百草枯中毒(APP)致肺损伤中的临床应用价值。方法将31例急性百草枯中毒致肺损伤且符合上呼吸机指征的患者随机分为LPSV组16例和传统机械通气组(对照组)15例。分别观察3～5d内(通气期间)两组的潮气量(VT)、呼气末正压(PEEP)、气道峰压(PIP)、平均气道压(MAP)等呼吸机参数;动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)等动脉血气指标;以及呼吸机相关性肺损伤(VALI)、X线胸片与患者的病死率。结果 LPVS组MAP水平低于对照组,差异有统计学意义(P<0.01),LPVS组患者的PIP、PEEP较对照组(P均<0.05);LPVS组患者的PaCO2、PaO2/FiO2高于对照组,差异均有统计学意义(P均<0.01),两组患者PaO2比较差异无统计学意义(P>0.05);LPVS组VALI的发生率低于对照组,X线胸片显示进展延缓病例数高于对照组(P均<0.05);两组患者的病死率无统计学差异(P>0.05)。结论采取LPVS可以一定程度改善APP肺损伤患者的呼吸功能、降低VALI的发生率,对APP导致的肺损伤有积极的治疗作用。

Objective To investigate the clinical value of lung-protective ventilation strategy （LPVS） in acute paraquat poisoning （APP）-induced lung injury. Methods Thirty- one patients with APP-induced lung injury were randomized into the LPVS group （16 cases） and conventional mechanical ventilation group （control group, 15 cases）. They were all in accordance with the indications of mechanical ventilator. In the ventilation period within 3- 5 days, the following indices of the two groups were observed： the ventilator parameters including volume tidal （VT）, positive end-expiratory pressure （PEEP）, peak inspiratory pressure （PIP）, mean airway pressure （MAP）; the arterial blood gas indicators including arterial partial pressure of oxygen （PaO2）, arterial partial pressure of carbon-dioxide （PaCO2）, oxygenation index （PaO2/ FiO2）; ventilator-associated lung injury （VALI）, chest X-ray and fatality. Results As compared to the control group, in the LPVS group the levels of MAP and PIP were lower （P 〈 0.01, P 〈 0.05, respectively）, whereas the levels of PEEP, PaCO2 and PaO2/ FiO2 were remarkably higher （P 〈 0.05, P 〈 0.01, P 〈 0.01, respectively）; the incidence of VALI was lower （P 〈 0.05）, and there were more patients whose process of lung injury was delayed revealed on the chest X-ray （P 〈 0.05）. Nevertheless, the level of PaO2 and the fatality showed no significant differences between the two groups （all P 〉0.05）. Conclusion The application of LPVS can improve the respiratory function of patients with APP-induced lung injury, reduce the incidence of VALI, thus has positive therapeutic effects on APP-induced lung injury.