两种有创机械通气模式在肺挫伤患者的比较研究

Comparison of the Effect of Two Kinds of Invasive Mechanical Ventilations in the Treatment of Pulmonary Contusion

目的比较两种有创机械通气治疗肺挫伤患者的效果。方法回顾分析2011年8月—2015年4月肺挫伤患者60例,所有患者均采取经口气管插管机械通气,分为治疗组(n=30),通气模式为适应性支持通气+呼气末正压;对照组(n=30),通气模式为同步间歇指令通气+压力支持通气+呼气末正压。观察两组机械通气情况和血气分析指标。结果治疗组的机械通气时间、住ICU时间和VAP发生率少于对照组(P<0.05)。治疗后两组的血气指标均优于治疗前(P<0.05),治疗组效果优于对照组[Pa O_2(64.8±3.0)mm Hg vs(62.2±2.3)mm Hg;Pa CO_2(39.8±2.9)mm Hg vs(42.3±1.5)mm Hg;Sa O_2(94.7±2.2)%vs(92.9±1.7)%;Pa O_2/Fi O_2(162.2±6.5)vs(154.7±5.8),均P<0.05]。结论肺挫伤患者采用ASV模式机械通气疗法可提高通气效果,改善血气指标,具有潜在的临床推广价值。

Objective To compare the effect of two kinds of invasive mechanical ventilations in the treatment of pulmonary contusion. Methods An analysis was conducted on 60 cases with pulmonary contusion enrolled from August 2011 to April2015. All the subjects were treated by mechanical ventilation with orotracheal intubation. The patients were divided into the treatment group（n=30） and the control group（n=30） according with different treatments. The treatment group received ASV and PEEP, while the control group received SIMV, PSV and PEEP. Mechanical ventilation and blood gas analysis indexes were observed in both groups. Results Compared with the control group, the treatment group had shorter duration of mechanical ventilation, less length of stay in the ICU and lower incidence rate of VAP, the differences were statistically significant, P〈0.05. After treatment, the values of blood gas indexes in both groups were better than those before treatment, P 0.05. Furthermore, the treatment group had better treatment effect than the control group after treatment in PaO2[（64.8±3.0）mmHg vs（62.2±2.3）mmHg）], PaCO2 [（39.8±2.9）mmHg vs（42.3±1.5）mmHg], SaO2[（94.7±2.2）% vs（92.9±1.7）%] and PaO2/FiO2 [（162.2±6.5） vs（154.7±5.8）], all P〈0.05. Conclusion ASV mode mechanical ventilation is a good treatment for patients with pulmonary contusion, which can improve the ventilation effect and blood gas indexes with the value of potential clinical promotion.