不同机械通气模式对ARDS患者血管外肺水及临床疗效的影响

Diverse mechanical ventilations on the extravascular lung water index and clinical outcomes in patients with ARDS

目的:探讨同步间歇指令通气(SIMV)、气道压力释放通气(APRV)和气道双相正压通气(BIPAP)三种不同的机械通气模式对于ARDS患者血管外肺水指数(EVLWI)及临床疗效的影响。方法:将28例接受机械通气的ARDS患者随机分为SIMV组、APRV组及BIPAP组,所有患者均采用限制性液体管理策略,合理使用抗生素,适当镇静及营养支持等综合治疗,呼吸机治疗均采用肺保护性通气策略维持SPO2在90%以上。监测患者接受机械通气后24 h、72 h两个时间段的EVLWI、氧合指数(PaO2/FiO2)及患者机械通气时间。结果:与SIMV组相比,BIPAP组、APRV组在通气24h、72 h后,氧合指数、EVLWI显著改善(P<0.05);同时机械通气天数减少(P<0.05);BIPAP组和APRV组相比,氧合指数、EVLWI及机械通气时间差异不显著(P>0.05)。结论:与SIMV相比,BIPAP和APRV明显改善ARDS患者氧合指数及EVLWI,并减少其机械通气时间。

Objective：To examine the effects of different protocol of mechanical ventilation,i.e.,synchronized intermittent mandatory ventilation（SIMV）,airway pressure release ventilation（APRV） or airway biphasic positive airway pressure ventilation（BIPAP） on the extravascular lung water index（EVLWI） and clinical outcomes in patients with acute respiratory distress syndrome（ARDS）.Methods：Twenty-eight patients with ARDS required mechanical ventilation were randomly allocated to groups of SIMV,APRV or BIPAP,and totally managed with fluid restriction under combined therapy of rational use of antibiotics,appropriate sedation and nutritional support.The ventilator supporting therapy was managed to favor the lung-protective ventilation by maintaining SpO2 over 90%.All patients were monitored for EVLWI and oxygenation index（PaO2/FiO2） after 24 h and 72 h of mechanical ventilation,respectively,and the duration of ventilation as well.Results：After 24 h and 72 h of mechanical ventilation,the oxygenation index and EVLWI were significantly improved in BIPAP AND APRV groups besides reduced days of ventilation requirement as compared with SIMV group（P0.05）,whereas no significant difference was seen between BIPAP and APRV group regarding the oxygenation index,EVLWI and persistence of mechanical ventilation（P0.05）.Conclusion：Both BIPAP and APRV are superior to SIMV for patients with ARDS by their desirable oxygenation index and EVLWI as well as reduced persistence of mechanical ventilation.