肺保护性通气策略治疗肺内和肺外源性急性呼吸窘迫综合征的临床对比

Lung protective ventilation strategies in the lungs and pulmonary exogenous clinical comparison of acute respiratory distress syndrome

目的对采取肺保护性通气策略治疗的肺内和肺外源性急性呼吸窘迫综合征的患者临床差异进行比较分析。方法选取诊断为急性呼吸窘迫综合征的患者86例,根据原发性、继发性分为两组:肺内急性呼吸窘迫综合征组(ARDSp组)和肺外源性急性呼吸窘迫综合征组(ARDSexp组)。对两组患者的呼吸力学、血气指标、平均上呼吸机时间和住院时间进行比较分析。结果肺保护性通气策略后30 s内PIP(气道峰压)、Pp1at(气道平台压)、Pm(平均气道压)均有明显提高(P<0.05);肺保护性通气策略后30 s,5 min,15 min,30 min ARDSp组和ARDSexp组肺Crs(肺顺应性)均明显增加,两组比较,ARDSexp组增加更显著(P<0.05)。复张后10 min,30 min,1 h,2 h两组的Sa O2,Pa O2,Pa O2/Fi02均增高(P<0.05),两组比较ARDSexp组增高更显著(P<0.05);Pa CO2复张前后无明显变化(P>0.05)。两组机械通气时间比较差异无统计学意义(P>0.05)。两组住院时间比较差异无统计学意义(P>0.05)。结论对于ARDS患者应用肺保护性策略进行治疗,能够改善患者的氧合,提高抢救成功率,改善患者的预后,对于肺外源性急性呼吸窘迫综合征治疗的效果明显优于肺内急性呼吸窘迫综合征。

Objective Clinical differences for patients taking exogenous pulmonary and lung protective ventilation in acute respiratory distress syndrome treatment strategies were compared.Methods Our hospital diagnosed 86 cases of patients with acute respiratory distress syndrome,according to the primary,secondary divided into two groups：the lungs of acute respiratory distress syndrome group（ARDSp group）and extrapulmonary acute respiratory distress syndrome group（ARDSexp group）. Two groups of patients with respiratory mechanics,blood gas analysis,the average time on the ventilator and hospital stay were compared.Results After lung protective ventilation strategy within 30 seconds PIP,Pp1at,Pm were significantly increased（P〈0.05）;30 seconds after lung protective ventilation strategies,5 minutes,15 minutes,30 minutes ARDSp group and ARDSexp lung Crs were significantly increased,the two groups,the group increased ARDSexp more significant （P〈0.05）;10 minutes laterrecruitment,30 minutes,1 hour,2 hours in both groups SaO2,PaO2,PaO2/FiO2 were increased（P〈0.05）,the two groups ARDSexp group increased more significantly（P〈 0.05）;no significant change（P〉 0.05）after PaCO2 recruitment;Mechanical ventilation time difference between the two groups was not statistically significance（P〉0.05）;Hospitalization time difference between the two groups was not statistically significant（P〉0.05）.Conclusion Application for ARDS patients with lung protective strategies for treatment,can improve the patient＇s oxygenation,improve the success rate,improve patient outcomes for lung exogenous treatment of acute respiratory distress syndrome is better than acute respiratory distress lungs sign.