双相气道正压通气及同步间歇指令通气对急性呼吸窘迫综合征治疗作用.doc

双相气道正压通气及同步间歇指令通气对急性呼吸窘迫综合征治疗作用[摘要] 目的：探讨双相气道正压（BIPAP）通气模式与同步间歇指令通气（SIMV）治疗急性呼吸窘迫综合征（ARDS）的疗效。方法：将26例ARDS患者随机分为BIPAP组和SIMV组行机械通气治疗，每组13例。每种模式通气6 h，稳定后分别记录两组的呼吸力学指标（RR、Vte、PIP、Pmean、Crs）、氧动力学指标（PaCO2、PaO2、SaO2、PaO2/FiO2）和血流动力学指标（HR、CVP、ABPM）。结果：两组的呼吸力学指标：RR、PIP、Pmean BIPAP组低于SIMV组（P0.05）。结论：BIPAP通气模式人机协同性好，肺损伤小，可改善氧合及呼吸力学效应，治疗ARDS优于SIMV。 [关键词] 双相气道正压通气；同步间歇指令通气；急性呼吸窘迫综合征 [中图分类号] R563.8[文献标识码]A [文章编号]1673-7210（2009）01（c）-012-03 The therapeutic effects of biphasic positive airway pressure mechanical ventilation in patients with acute respiratory distress syndrome compared with synchronous intermittent mandatory ventilation HE Hui-jie, WANG Hui-min, ZHANG Dong, ZHAO Gang, WANG Chun-na, MA Yao (Department of Respiratory Disease, the First Affiliated Hospital of Baotou Medical College, Baotou014010, China) [Abstract] Objective: To explore the effect of biphasic positive airway pressure (BIPAP) mechanical ventilation on patients with acute respiratory distress syndrome (ARDS) compared with synchronous(ARDS) intermittent mandatory ventilation (SIMV). Methods: Twenty-six ARDS patients were randomly divided into BIPAP group and SIMV group, with 13 patients in each group. The indexes of respiratory mechanics (RR, Vte, PIP, Pmean and Crs), oxygen kinetic (PaCO2, PaO2, SaO2, PaO2/FiO2) and hemodynamic parameters (HR, CVP, ABPM) were recorded in both groups after each mechanical ventilating for six hour. Results: RR, PIP and Pmean in BIPAP group were lower than those in SIMV group (P0.05). Conclusion: BIPAP is an effective mode of mechanical ventilation therapy for ARDS patients, better than SIMV. [Key words] Biphasic positive airway pressure; Synchronous intermittent mandatory ventilation; Acute respiratory distress syndrome 机械通气是急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）的关键性治疗措施，如何正确、恰当地应用机械通气，直接关系到ARDS抢救的成败。然而，长期使用常规通气模式常常引起呼吸机所致肺损伤（ventilator-induced lung injury, VILI），导致ARDS患者的病死率仍较高。针对VILI的致伤因素，必须实行肺保护性通气策略[1]。本研究拟比较BIPAP与SIMV两种模式对ARDS患者呼吸力