急性呼吸衰竭患者有创机械通气策略的临床研究

Mechanical Ventilation Strategy on Severe Respiratory Failure

目的:探讨严重呼吸衰竭有创机械通气策略。方法:选取我院2015年5月-2016年12月收治的严重呼吸衰竭患者80例为研究对象,将80例患者随机分为两组,研究组患者有40例,对照组患者有40例。为两组患者进行容量控制同步间歇指令通气模式,持续有创机械通气48小时,研究组患者的潮气量在6-8 ml/kg,呼吸末正压5-9 cm H_2O,对照组患者的潮气量在6-8 ml/kg,呼吸末正压11-21 cm H_2O。对比不同的呼吸末正压和潮气量对患者的血流动力学,动脉血氧分压,氧合指数等指标的影响,分析两组患者的气道压伤发病率和临床死亡率。结果:研究组患者的气道压伤发病率显著低于对照组(20%vs 2.5%,P<0.05)。研究组死亡率明显低于对照组(30%vs 50%,P<0.05)。结论:对于严重呼吸衰竭需要有创机械通气的患者,采用肺保护通气策略,能够降低气道压伤率和死亡率,值得在临床推广应用。

Objective:The objective of the present investigation was to analyze the mechanical ventilation strategy on severe respiratory figure. Methods:Eighty cases of severe respiratory failure recruited in our hospital from February 2015 to December 2016 were selected as the research subjects in this study,randomly divided into two groups,40 patients in the study group and 40 cases in the control group. Capacity control synchronized intermittent mandatory ventilation was conducted on the patients in the two groups with continuous invasive mechanical ventilation for 48 hours.Both the tidal volume of the study group and the control group were 6-8ml/kg. Positive end expiratory pressure of the study group and the control group were 5-9 cm H_2O and 11-21 cm H_2O,respectively. The effects of different positive ende xpiratory pressure and tidal volume on the hemodynamics,arterial oxygen pressure,oxygenation index and other indices of the patients were compared. The airway pressure injury incidence and clinical mortality incidence of the patients from the two groups were analyzed. Results:The incidence of airway pressure injury in the study group was significantly lower than that of the control group(20% vs 42.5%,P<0.05). The mortality rate in the study group was significantly lower than that of the control group(30% vs 50%,P<0.05). Conclusions:Mechanical ventilation is widely used in the treatment of severe respiratory failure disease. Invasive mechanical ventilation strategy can effectively reduce the total time of mechanical ventilation and hospitalization time in patients with lower airway pressure,and decrease airway pressure injury rate and mortality. Therefore,it is worthy of popularizing in clinical application.