高呼气末正压通气治疗蛛网膜下腔出血并神经源性肺水肿的效果分析

Analysis of the effect of high positive end-expiratory pressure ventilation in the treatment of subarachnoid hemorrhage complicated with neurogenic pulmonary edema

目的:探讨机械通气时使用高呼气末正压(PEEP)治疗蛛网膜下腔出血并神经源性肺水肿的临床效果。方法:2009年1月-2019年1月收治蛛网膜下腔出血并神经源性肺水肿患者35例,根据机械通气时设置呼气末正压的高低分为两组。高PEEP组PEEP设置为8~16 cmH2O;低PEEP组PEEP设置为3~7 cmH2O。对比两组治疗效果。结果:高PEEP组治疗后PaO2、PO2/FiO2指标水平高于低PEEP组,高PEEP组PaCO2、A-aDO2指标水平低于低PEEP组,高PEEP组机械通气时间、住院时间均短于低PEEP组,高PEEP组死亡率低于低PEEP组,差异均有统计学意义(P<0.05)。结论:机械通气时给予高呼气末正压可明显改善蛛网膜下腔出血并神经源性肺水肿患者血氧状况,有效缩短机械通气时间及住院时间,降低死亡率。

Objective:To explore the clinical effect of high positive end-expiratory pressure(PEEP)in the treatment of subarachnoid hemorrhage and neurogenic pulmonary edema(NPE)in mechanical ventilation.Methods:From January 2009 to January 2019,35 cases of subarachnoid hemorrhage with NPE were enrolled,they were divided into two groups according to the mechanical ventilation,the high and low positive pressure of the end expiratory pressure.The PEEP of the high PEEP group was set to 8 to 16 cmH2O,the PEEP of the low PEEP group was set to 3 to 7 cmH2O.The treatment effects between the two groups were compared.Results:After treatment,the level of PaO2、PO2/FiO2 in high PEEP group was higher than in low PEEP group,the PaCO2、A-aDO2 index level in high PEEP group was lower than in low PEEP group,the mechanical ventilation time and hospitalization time in high PEEP group were shorter than in low PEEP group,and the mortality in high PEEP group was lower than in low PEEP group,the differences were statistically significant(P<0.05).Conclusion:The high positive end-expiratory pressure in mechanical ventilation can significantly improve the blood oxygen status of patients with subarachnoid hemorrhage complicated with neurogenic pulmonary edema,the mechanical ventilation time and the hospital stay time are effectively shortened and the mortality rate is reduced.