急性呼吸窘迫综合征的机械通气停机策略

Ventilator weaning strategy in the patients with acute respiratory distress syndrome

目的 提出在急性呼吸窘迫综合征 (ARDS)病人机械通气期间 ,采用综合方法维持内环境稳定创造条件停机的重要性。方法 本组共 32例 ,机械通气后 ,尽可能维持相对满意氧供 ,尽量避免大量输液 ,尤其是晶体液 ;每天维持 (12 1± 2 6 ) k J/ kg能量供应 ;维持红细胞压积在 0 .35左右 ,维持满意血浆胶体渗透压 ;有效排痰 ,根据痰培养结果应用抗菌谱相对较窄的广谱抗生素以控制肺部感染 ,尽量避免双重感染 ;每天保持 30 0～ 5 0 0m L轻度出超 ;从开始机械通气起 ,应特别重视胃肠道功能恢复 ,避免因腹胀、膈肌抬高所致肺容量减少而影响停机 ;停机前通常采用 Bi PAP/ SIMV模式过渡。结果 全组顺利停机者 2 4例 ,其中存活 2 0例 ,死亡 12例 ,存活率6 2 %。结论 使用机械通气目的就是停用机械通气 ,采用综合方法维持内环境的稳定是非常有效的

Objective To emphasize the combined strategy for maintaining homeostasis during the mechanical ventilation in the patients with acute respiratory distress syndrome so as to cease the ventilation.Methods There were 32 cases in our group,24 males and 8 females.During the mechanical ventilation,relatively satisfied oxygen supply was maintained as well as possible,large-volumed transfusion shoud be avoided,especially crystalloid solution should be strictly controlled.The nutrition of (121±26) kJ/kg was supplied per day.Hct was kept at about 0.35,satisfied plasma colloid osmotic pressure was managed.The proper antibiotics were taken according to the sputum culture,and managed to avoid secondary infection.Volume of urine was 300～500 mL more than the water intake per day.Form the beginning of mechanical ventialtion it was very important for the patients to recover their gastrointestinal function.The flatulence and diaphragm elevation may decrease the lung capacity and affect the ventilator weaning,this must be avoided.Biphasic intermittent positive airway pressure (BiPAP) and synchronized intermittent mandatory ventilation (SIMV) were generally taken before the mechanical ventilation stopped.Results In our group 24 patients underwent smooth ventilator weaning,20 patients survived,but 12 died,with a survival rate 62%.Conclusion The main purpose of mechanical ventilation is just to cease the ventilation.The combined management of maintaining homeostasis is an effective ventilator weaning strategy.