肺保护性通气策略治疗急性呼吸窘迫综合征的临床观察.docVIP

肺保护性通气策略治疗急性呼吸窘迫综合征的临床观察 　　【摘要】 目的：观察肺保护性通气策略对急性呼吸窘迫综合征患者的机械通气疗效。方法：本研究采用随机、对照的方法，将60例需要机械通气治疗的急性呼吸窘迫综合征患者分为两组，治疗组采用潮气量5～8 ml/kg，PEEP为静态P-V曲线低位转折点压力之上2 cm H2O，气道平台压不超过30～35 cm H2O的肺保护性通气策略，对照组采用量8～15 ml/kg，PEEP为4～8 cm H2O，气道平台压不超过35～40 cm H2O的常规通气策略。观察治疗前后患者血气分析pH、PO2、PCO2、氧合指数等指标及病死率的情况。结果：治疗组在机械通气第1天、第3天氧合指数、PO2均优于对照组，差异均有统计学意义（P0.05）；治疗组病死率较对照组低，差异有统计学意义（P0.05）。结论：对ARDS患者采取小潮气量、限制气道平台压和适当PEEP的肺保护性通气策略，可改善机械通气治疗效果及预后。 　　【关键词】 急性呼吸窘迫综合征； 机械通气； 肺保护性通气策略； 小潮气量； 呼气末正压； 气道平台压； 血气分析 　　中图分类号 R56 文献标识码 A 文章编号 1674-6805（2016）10-0013-02 　　【Abstract】 Objective：To observe the effect of lung protective ventilation strategies on patients with acute respiratory distress syndrome（ARDS）.Method：Sixty patients with acute respiratory distress syndrome which needed mechanical ventilation were divided into two groups according to the randomized，controlled method.Lung protective ventilation strategies with tidal volume of 5-8 ml/kg，PEEP of 2 cm H2O above the low inflection point of static PV curves，airway pressure platform of 30-35 cm H2O were used to the treated group，while routine ventilation strategies with tidal volume of 8-15 ml/kg，PEEP of 4-8 cm H2O， 　　airway pressure platform of 35-40 cm H2O were used in the control group.The changes of pH，PO2，PCO2 of blood gas analysis and mortality after the ventilation were observed.Result：One and three days after ventilation，oxygenation index and PO2 of the treated group were superior than the control group，the differences had statistical significance（P0.05）.The mortality of the treated group was lower than the control group，the difference had statistical significance（P0.05）.Conclusion：Lung protective ventilation strategies with low tidal volume，limited airway pressure platform and suitable PEEP could improve the ventilation efficacy and prognosis in patients with acute respiratory distress syndrome. 　　【Key words】 Acute respiratory distress syndrome； Ventilation； Lung protective ventilation strategies； Low tidal volume； Positive end