小潮气量联合呼气末正压在恙虫病合并急性肺损伤中的应用

Study on Application of Low Tidal Volume Combined with Positive End-expiratory Pressure in Acute Lung Injury Caused by Tsutsugamushi Disease

目的观察小潮气量联合呼气末正压(PEEP)在恙虫病合并急性肺损伤中的临床效果。方法选择2008年1月至2012年12月肇庆市第一人民医院重症监护病房(ICU)收治的恙虫病合并急性肺损伤患者30例,按随机数字表法分为观察组(14例)和对照组(16例)。观察组患者采用小潮气量联合PEEP通气,对照组予常规潮气量通气。比较两组治疗后的呼吸力学、血气分析、机械通气时间、ICU住院时间及住院费用的变化。结果治疗后,两组患者的呼吸频率、呼吸道峰压(Ppeak)、潮气量均较治疗前显著下降,Cst显著上升(P<0.05),且观察组肺静态顺应性(Cst)、Ppeak、呼吸道平台压力的改善程度优于对照组(P<0.05);两组患者的血氧分压/氧合指数(Pa O2/FIO2)均显著高于治疗前,肺泡-动脉氧分压差(PA-a DO2)低于治疗前,且观察组Pa O2/FIO2、PA-a DO2改善程度均优于对照组(P<0.05)。观察组患者的机械通气时间、ICU住院时间及住院费用均显著低于对照组,差异有统计学意义(P<0.05)。结论小潮气量联合PEEP既能改善恙虫病合并急性肺损伤的病情,又能降低住院费用。

Objective To study the effect of low tidal volume combined with positive end-expiratory pressure（ PEEP） in acute lung injury（ ALI） caused by tsutsugamushi disease. Methods A total of 30 patients with acute lung injury caused by tsutsugamushi disease combined with ALI admitted to intensive care unit（ ICU） in Zhaoqing First People＇ s Hospital,from Jan. 2008 to Dec. 2012 were randomly divided into observation group（ 14 cases） and control group（ 16 cases）,the observation group was treated with low tidal volume combined with PEEP,while the control group was treated with conventional tidal volume. Respiratory mechanics,blood gas analysis,duration of mechanical ventilation,ICU stay length and hospital costs of the two groups after treatment were compared. Results After treatment,the respiratory rate,peak airway pressure（ Ppeak）,tidal volume of both groups decreased significantly compared with pre-treatment,while a significant increase in Cst（ P〈0. 05） was observed,and the improvement of Cst,Ppeak,respiratory plateau pressure of the observation group were all better than the control group（ P〈0. 05）; the blood oxygen pressure,oxygenation index（ Pa O2/ FIO2） were significantly higher than before treatment,alveolar-arterial oxygen difference（ PA-a DO2） was lower than before treatment,and the Pa O2/ FIO2,PA-a DO2 improvement degree of the observation group were all better than the control group（ P〈0. 05）. Duration of mechanical ventilation,ICU stay length and hospital costs of the observation group were significantly lower than the control group,the difference was statistically significant（ P〈0. 05）. Conclusion Low tidal volume combined with PEEP is an effective therapy for ALI caused by tsutsugamushi disease,which can also lower the hospitalization cost.