摘要
目的对ICU60例严重多发伤患者的机械通气治疗进行探讨。方法回顾性分析60例严重多发伤患者机械通气治疗的资料,主要指标是呼吸机治疗模式、病人的潮气量、能反应呼吸功能的血气分析、血常规和胸片,次要指标是呼吸功能的发展,如急性肺损伤程度、机械通气持续时间和是否死亡等。结果严重多发伤患者入ICU第1个24小时均进行容量复苏,10例机械通气治疗>72小时。较低潮气量的患者没有发生急性肺损伤,而较高潮气量患者合并脓毒症25例、多器官功能不全24例、腹腔间隙综合征8例。60例患者ICU住院时间3～34天,死亡8例,死亡原因为脑疝形成3例、失血性休克并弥漫性血管内凝血1例、MODS3例、心脏停搏1例。多数患者在加强治疗原发伤的基础上,采用肺保护性较低潮气量机械通气、限制性液体复苏、控制系统性炎症反应、增强免疫等综合治疗,取得较好的效果。结论肺保护性较低潮气量机械通气是严重多发伤患者呼吸支持的一个重要技术,有效和适当的机械通气可降低呼吸机相关的肺损伤的发生。
Objective To discuss the treatment of severe multiple trauma by mechanical ventilation in ICU.Methods Data on 60 cases of severe trauma treated by mechanical ventilation were reviewed,focusing on indicators involving therapeutic mode by breathing machine,tidal volume,blood gas analysis,routine test of blood,X ray.In addition,development of respiratory function was also observed,including degree of acute lung injury,duration of mechanical ventilation,death or survival.Results Patients received volume resuscitation within 24 hours following admitting ICU,and 10 patients received mechanical ventilation by 〉72 hours.There was no acute lung injury in patients with lower tidal volume.But for higher tidal volume patients,sepsis was observed in 24 cases,multiple organ dysfunction in 24 cases,abdominal compartment syndrome in 8 cases.The hospitalization of 60 patients was 3-34 days.Eight patients died due to herniation of brain in 3 cases,hemorrhagic shock combined with diffuse intravascular coagulation in 1 case,MODS in 3 cases,asystole in 1 case.Lung protective strategies with applying low tidal volumes and limited fluid resuscitation,controlling systemic inflammation response and increasing immunization were recommended to prevent tidal alveolar collapse and over distension in patients with severe multiple trauma.Conclusion Lung-protective ventilation strategy with lower tidal volume remains an important clinical tool for respiratory support.Effective and proper mechanical ventilation can decrease the incidence of lung injury related to breathing machine.
出处
《创伤外科杂志》
2011年第1期12-14,共3页
Journal of Traumatic Surgery
关键词
多发伤
肺损伤
机械通气
polytrauma
lung injury
mechanical ventilation
