两种肺保护通气模式在重症创伤性湿肺通气策略中的比较

Comparison of two lung protective ventilation modes in severe traumatic wet lung with lung ventilation strategy

目的 比较两种肺保护通气模式在重症创伤性湿肺时施行肺保护通气策略中的临床意义.方法 将92例重症创伤性湿肺患者按随机数字表法分为适应性支持通气（ASV）组和压力型同步间歇指令通气（P-SIMV）＋压力支持通气（PSV）组,每组46例,比较两组患者机械通气后30 min的心率、平均动脉压（MAP）、pH值、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaC O2）、每分钟通气量、潮气量、总呼吸频率、气道峰压、平均气道压、气道闭合内压、肺顺应性.结果 机械通气后30 min,两组患者心率、MAP、pH值、PaO2、PaCO2、平均气道压、气道峰压、气道闭合内压比较差异均无统计学意义（P＞0.05）,但ASV组潮气量、每分钟通气量、总呼吸频率、肺顺应性均较P-SIMV＋PSV组明显改善[（692.6±38.6） ml比（558.5±25.6） ml、（8.9±1.7）L比（7.8±1.6）L、（16.3±3.3）次/min比（21.3±3.2）次/min、（42.15±5.28） ml/cmH2O（1 cmH2O=0.098 kPa）比（39.15±5.47） ml/cmH2O],差异均有统计学意义（P＜0.01或＜0.05）.结论 对于重症创伤性湿肺患者在施行肺保护通气策略时,ASV可根据患者的呼吸力学状况自动调整吸气压力支持水平,提高潮气量、增加肺顺应性、降低呼吸频率,而对血流动力学和生命体征无明显影响.

Objective To compare the clinical effective of two lung protective ventilation modes in severe traumatic wet lung （STWL） with lung ventilation strategy.Methods Ninety-two cases of STWL patients were divided into adaptive support ventilation （ASV） group and pressure type synchronous intermittent aeration instruction （P-SIMV） ＋ pressure support ventilation （PSV） group with 46 cases by random number table method in each.Heart rate,mean arterial pressure （MAP）,pH value,arterial blood oxygen partial pressure （PaO2）,arterial bold carbondioxide partial pressure （PaCO2）,minute ventilation,tidal volume,total respiratory frequency,airway peak pressure and mean airway pressure,airway closure pressure,and pulmonary compliance at 30 min after mechanical ventilation were compared between two groups.Results At 30 min after mechanical ventilation,heart rate,MAP,pH value,PaO2,PaCO2 and mean airway pressure,airway peak pressure and airway closure pressure between two groups had no statistical significance （P 〉0.05）.But tidal volume,minute ventilation,total respiratory frequency,pulmonary compliance in ASV group were obviously improved compared with those in P-SIMV ＋ PSV group [（692.6 ± 38.6） mlvs.（558.5±25.6）ml,（8.9± 1.7） Lvs.（7.8± 1.6） L,（16.3±3.3） times/min vs.（21.3±3.2）times/min,（42.15 ± 5.28） ml/cmH2O （1 cmH2O =0.098 kPa） vs.（39.15±5.47） ml/cmH2O] （P 〈 0.01 or 〈0.05）.Conclusion For patients with STWL in the lung protective ventilation strategy,ASV can automatically adjust the level of inspiratory pressure support according to the respiratory mechanics condition of the patients,improving tidal volume and pulmonary compliance,and reducing respiratory rate,which has no obvious effect on the hemodynamics and vital signs.