体外循环术后ARDS的肺保护性通气治疗.pdfVIP

中南大学学报(医学版) J Cem Sout^Un ( d Sci) 2007，32(6) 1080 体外循环术后ARDS的肺保护性通气治疗 曹 亮，杨一峰，杨进福 (中南大学湘雅二医院心胸外科，长沙41OOl1) [摘要] 目的 ：探讨体外循环术后急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS) 的早期诊断和呼吸机“肺保护性”通气治疗。方法：手术病人分成传统机械呼吸+终末正压通气(posi． tive end expiratory pressure，PEEP)组(13例)和呼吸机“肺保护性”通气组(21例)。回顾分析两组病人体 外循环术后ARDS的诊治过程。结果 ：传统机械通气+PEEP组带机时间(7．2±3．6)d，死亡8例，病 死率61．5％ ；呼吸机“肺保护性”通气组带机时间(4．8±2．1)d，死亡5例，病死率23．8％，两组比较 差异有统计学意义(P0．05)。结论：早期诊断和及时治疗是该病治疗的关键，呼吸机“肺保护性”通 气治疗ARDS比传统机械呼吸 +PEEP效果更优越，同时积极处理原发损伤和预防各种并发症也很 重要。 [关键词] 体外循环； 急性呼吸窘迫综合征； 呼吸机治疗 [中图分类号] R654．1；R563．8 [文献标识码] A [文章编号] 1672-7347(2007)06—1080-05 Mechanical ventilation treatment on acute respiratory distress syndrome in operations by cardiopulmonary bypass CAO Liang，YANG Yi—feng，YANG Jin-fu (Department of Cardiothorcwie Surgery，Second Xiangya Hospital，Central South University，Changsha 41O011，China) Abstract： Objective To explore the early diagnosis of acute respiratory distress syndrome (ARDS)and the mechanical ventilation treatment in operations of cardiopulmonary bypass．Methods Thirty--four patients with acute respiratory distress syndrome were divided into the traditional ventila- tion strategy plus positive end expiratory pressure(PEEP)group(n=1 3)and the protective venti- lation strategy group(n=2 1)，and their diagnosis and treatment were reviewed．Results The average ventilator--carrying time in the protective ventilation strategy group and the traditional ventila- tion strategy plus PEEP group was(4．8±2．1)and(7．2±3．6)days，and the mortality was 23．8％ and 61．5％ respectively．There was statistical significance i