有创及无创序贯性机械通气联合治疗连枷胸合并肺挫伤.doc

有创及无创序贯性机械通气联合治疗连枷胸合并肺挫伤 　【摘要】 　　目的 ：探讨有创与无创序贯性机械通气治疗连枷胸合并肺挫伤的效果。方法：24例连枷胸合并严重肺挫伤的患者，随机分为序贯组和对照组：当压力支持通气（PSV）水平降至10 cmH2O、呼气末正压（PEEP）降至2 cmH2O时，序贯组拔除气管插管，行无创通气治疗；对照组仍然使用气管插管机械通气，逐渐降低通气频率至5次/min，后减低PSV至7 cmH2O、PEEP降至0 cmH2O，再脱机拔管。记录序贯组和对照组机械通气前、序贯组拔管前0.5 h与无创通气2 h后的呼吸频率(Rr）、心率（HR）、动脉血pH值（pHa）、收缩压（SBP）、氧合指数 (PaO2/FiO2)、动脉血二氧化碳分压（PaCO2）等指标。记录两组资料接受机械通气总时间及发生呼吸机相关性肺炎（ventilator associated pneumonia，VAP）的例数。结果：序贯组与对照组比较，VAP的发生例数差异有显著性（5 vs 11，P lt;0.05），总机械通气时间差异有显著性[（15±3）d vs（18±2）d，P lt;0.05]，入住ICU时间差异有显著性[（17±3）d vs（20±2）d，P lt;0.05]。结论 ：有创与无创序贯性机械通气可用于治疗连枷胸合并肺挫伤，与传统的治疗方法相比可显著减少呼吸机相关性肺炎的发生，并减少患者总机械通气时间及入住ICU时间。 【关键词】 连枷胸 肺挫伤 机械通气 　　Abstract: Objective: To explore the effect of invasive and sequential non-invasive mechanical ventilation in flail chest combined with pulmonary contusion. Methods: Twenty-four patients with flail chest and pulmonary contusion were randomly divided into invasive and sequential non-invasive mechanical ventilation (MV) group and control group. The early extubation was conducted and followed by non-invasive MV via facial mask with S/T mode immediately when the ventilated frequency was decreased to 10， PSV to 10 cmH2O and PEEP to 2 cmH2O in 12 cases (study group). Invasive MV were still performed in all patients in the other 12 cases (control group) when the ventilated frequency was decreased to 5 and PSV to 7 cmH2O， PEEP to 0 cmH2O， then extubate and stop mechanical ventilation. The respiratory rate (RR)， heart rate (HR)，oxygenation index，arterial partial pressure of carbon dioxide (PaCO2)，the systolic blood pressure (SBP)，the blood pH，the duration of ICU stay and the incidence of ventilation associated pneumonia (VAP) in different time were recorded. Results: Compared the invasive and sequential non-invasive mechanical ventilation group with the control group， the occurrence of VAP （5 vs 11，P lt;0.05）， the total time of mechanical ventilation （15±3 d vs 18±2 d，P lt;0.05） and the time of patient’s stay in the ICU had significant differ