跨肺压导向的呼气末正压通气在急性呼吸窘迫综合征的临床应用效果

Application of transpulmonary pressure guided positive end-expiratory pressure ventilation in acute respiratory distress syndrome

目的探讨以跨肺压导向的呼气末正压通气在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床应用效果。方法将2020年1月—10月重症医学科收治的100例ARDS患者随机分为对照组和观察组各50例,对照组采用小潮气量辅助控制通气治疗,观察组以跨肺压(transpulmonary pressure,Ptp)为导向选择最佳呼气末正压(positive end-expiratory pressure,PEEP)进行机械通气治疗,观察比较两组患者治疗前和治疗48 h的呼吸动力学指标、血气分析指标,随访28 d病死率。结果治疗48 h,潮气量、PEEP、肺静态顺应性、PaCO_(2)、PaO_(2)、SaO_(2)、PaO_(2)/FiO_(2)观察组明显高于对照组(P<0.05);随访28 d病死率观察组和对照组比较差异无统计学意义(P>0.05)。结论以Ptp为导向选择最佳PEEP的机械通气治疗ARDS可以有效改善患者的呼吸动力学指标和血气分析指标,不增加ARDS的病死率,值得临床推广应用。

Objective To investigate the clinical effect of positive end-expiratory pressure(PEEP)ventilation guided by transpulmonary pressure(Ptp)in acute respiratory distress syndrome(ARDS).Methods Between January and October 2020,100 cases of ARDS treated in intensive care unit were randomly divided into control group and observation group with 50 cases each.Control group used auxiliary control small tidal volume ventilation therapy,and observation group used the best PEEP mechanical ventilation therapy with the guiding of Ptp.The respiratory dynamics index,blood gas analysis results,follow-up of 28d case fatality rate before and 48h after treatment between the two groups were compared.Results After 48h of treatment,tidal volume、PEEP、pulmonary static compliance、PaCO_(2)、PaO_(2)、SaO_(2)、PaO_(2)/FiO_(2) of the observation group were all higher than those of the control group(P<0.05).There was no statistically significant difference in mortality between the two groups at 28d follow-up(P>0.05).Conclusion Mechanical ventilation with the best PEEP guided by Ptp could effectively improve the respiratory dynamic index and blood gas analysis results of patients with ARDS,without increasing the mortality of ARDS,which is worthy of clinical application.