呼气末正压通气治疗急性呼吸窘迫综合征的效果

The effect of positive end expiratory pressure in the treatment of acute respiratory distress syndrome

目的探讨呼气末正压通气（PEEP）对急性呼吸窘迫综合征的疗效。方法选取本院2009年3月-2011年12月重症医学科收治的50例急性呼吸窘迫综合征患者,经常规治疗无效后,加用PEEP（5-8 mmHg）机械通气治疗,对比治疗前后心率（HR）、呼吸频率（RR）、血氧饱和度（SaO2）、氧合指数（PaO2/FiO2）,以及血气指标如氧分压（PaO2）、二氧化碳分压（PaCO2）等指标的变化。结果 50例患者经PEEP机械通气治疗后,其中40例在1 d内,呼吸困难改善,发绀明显好转,肺部湿啰音基本消失,仅肺底残留少许固定湿啰音,HR减慢（P〈0.05）、RR减慢（P〈0.05）、SaO2上升（P〈0.05）,PaO2/Fi O2明显升高（P〈0.05）,低氧血症均有不同程度的改善。血气指标显示Pa O2上升（P〈0.05）,pH有所改善（P〈0.05）,但PaCO2在PEEP治疗前后差异无统计学意义（P〉0.05）。10例因严重脓毒性休克,循环衰竭,治疗无效而死亡。PEEP机械通气治疗急性呼吸窘迫综合征,总有效率为80%。结论 PEEP是治疗急性呼吸窘迫综合征快速且有效的方法 ,可作为重要的治疗手段。

Objective To explore the efficacy of positive end expiratory pressure（PEEP） in the treatment of acute respiratory distress syndrome. Methods 50 patients with acute respiratory distress syndrome（ARDS） admitted to our hospital from August 2007 to June 2013 were selected,PEEP（5-8 mm Hg） mechanical ventilation was added after the ineffective conventional treatment.And then the heart rate（HR）,respiratory rate（RR）,oxygen saturation（Sa O2）,partial pressure of oxygen（Pa O2）,carbon dioxide partial pressure（Pa CO2）,pxygenation index（Pa O2/Fi O2） were compared before and after treatment. Results 50 cases of patients treated with PEEP,40 cases were improved dyspnea,cyanosis markedly in a day.Their Pulmonary rales disappeared and only a small residual lung bases fixed rales.The outcomes showed HR decreased（P〈0.05）,RR decreased（P〈0.05）,Sa O2 was increased（P〈0.05）,and Pa O2/Fi O2 was increased（P〈0.05）.There were different degrees of hypoxemia improvements.In addition,Pa O2 was increased（P〈0.05） and p H was improved（P〈0.05）,but there was no significant difference in Pa CO2 before and after treatment（P〈0.05）.10 cases with severe septic shock,circulatory failure,treatment failure were dead.The total efficiency of PEEP mechanical ventilation for acute respiratory distress syndrome was 80%. Conclusion PEEP is a fast and effective treatment method for acute respiratory distress syndrome,can be used as an important means of treatment.