肺保护性通气策略对ICU机械通气患者呼吸功能及术后肺部并发症的影响

Effects of Lung Protective Ventilation Strategies on Respiratory Function and Postoperative Pulmonary Complications in ICU Patients Undergoing Mechanical Ventilation

目的:探讨肺保护性通气策略(LPVS)对ICU机械通气(MV)患者呼吸功能及术后肺部并发症(PPCs)的影响。方法:选择我院ICU 60例术后MV患者,依照随机数字表,随机分为常规MV组(CMV组)30例和肺保护性通气策略组(LPVS组)30例。比较两组MV即刻(T_(1))、MV 12h(T_(2))、MV 24h(T_(3))呼吸功能(呼吸力学参数:Ppeak、Pplat、Cdyn,氧合指标:PaO_(2)、PaCO_(2)、OI),记录两组术后72h PPCs发生率。结果:T_(1)时,两组呼吸力学参数和氧合指标比较差异无统计学意义(P>0.05)。T_(2)、T_(3)时,LPVS组Ppeak、Pplat低于CMV组(P<0.05),Cdyn高于CMV组(P<0.05);LPVS组PaO_(2)、OI高于CMV组(P<0.05),PaCO_(2)低于CMV组(P<0.05)。LPVS组术后72h PPCs发生率为6.67%,低于CMV组的26.67%(P<0.05)。结论:LPVS可改善ICU MV患者的呼吸功能,降低术后72h PPCs发生率。

Objective:To investigate the effects of lung protective ventilation strategies(LPVS)on respiratory function and postoperative pulmonary complications(PPCs)in ICU patients undergoing mechanical ventilation.Methods:60 patients with postoperative mechanical ventilation in ICU of our hospital were randomly divided into conventional mechanical ventilation group(group CMV)with 30 patients and lung protective ventilation strategies group(group LPVS)with 30 patients according to the random number table.The respiratory function(respiratory mechanics parameters:Ppeak,Pplat,Cdyn,oxygenation indexes:PaO_(2),PaCO_(2),OI)immediately after mechanical ventilation(T_(1)),at 12 hours after mechanical ventilation(T_(2)),at 24 hours after mechanical ventilation(T_(3))were compared in the two groups,and the incidence of PPCs in 72 hours after operation was recorded in the two groups.Results:At T_(1),there were no significant difference in respiratory mechanics parameters and oxygenation indexes in the two groups(P>0.05).At T_(2)and T_(3),Ppeak and Pplat in group LPVS were lower than those in group CMV(P<0.05),while Cdyn was higher than that in group CMV(P<0.05);PaO_(2)and OI in group LPVS were higher than those in group CMV(P<0.05),and PaCO_(2)was lower than that in group CMV(P<0.05).The incidence of PPCs in 72 hours after operation in group LPVS was 6.67%,which was lower than that in group CMV(26.67%)(P<0.05).Conclusion:LPVS could improve the respiratory function and reduce the incidence of PPCs in 72 hours after operation in ICU patients with mechanical ventilation.