摘要
目的研究机械通气治疗的急性肺损伤／急性呼吸窘迫综合症（ALI／ARDS）高风险患者，应用小潮气量通气对患者疗效和预后的影响。方法采用随机数字表法将本院重症监护病房（ICU）收治的56例ALI／ARDS高风险患者分为研究组和对照组各28例，研究组采用小潮气量（VT6～8ml／kg）通气治疗，对照组采用常规潮气量（VT10～12ml／kg）通气治疗，比较两组患者治疗后不同时间的血气指标、血清炎症变化及预后差异。结果通气48h、通气96h后两组患者的PaO2、PaCO2、氧饱和度、pH值、氧合指数、中心静脉压均较通气即刻显著好转（P〈0．05）。通气48h、通气96h后两组患者的血清IL-6、TNF-α、CRP水平均较通气即刻显著的降低（P〈0．05），研究组在通气48h、通气96h后血清IL-6、TNF—α、CRP水平均显著的低于对照组（P〈0．05）。研究组的ALI／ARDS发病率（14．29％）、ICU治疗时间（9．5±2．6）d、机械通气治疗时间（7．4±1．3）d、住院时间（13．7±3．2）d、死亡率（10．71％），均显著的低于对照组患者（P〈0．05）。结论ALI／ARDS高风险患者应用小潮气量机械通气治疗，较常规潮气量通气治疗具有更好的临床效果，预后效果更好。
Objective To study the effect of low tidal volume ventilation on patients with high risk of ALl/ ARDS and prognosis. Methods 56 patients with ALl/ARDS high risk were randomly divided into the study group and the control group, 28 cases in each group. The study group was given low tidal volume （VT6 -8ml/kg） ventilation, and the control group was treated with conventional tidal volume （ VTIO - 12ml/kg） ventilation, ents after treat- ment at different time of blood gas index, serum levels of inflammatory changes and the prognosis of patients with dif- ferent. Results The levels of PaO2 , PaCO2 , oxygen saturation, pH, oxygenation index and central venous pressure were significantly improved in the two groups （ P 〈 0. 05 ） , which was significantly better in the ventilation group. The levels of serum IL-6, TNF alpha and CRP decreased significantly in the two groups （ P 〈 0.05 ） , and they were significantly lower in the study group than in the control group （ P 〈 0. 05 ）. The incidence of ALI/ARDS was 14. 29%, the duration in ICU was （9. 5 ± 2. 6） d, the time of mechanical ventilation （7. 4 ±1.3） d, the duration of hospital stay was （1.37 ±3.2 d）, and the mortality was 10. 71% in the study group, which were significantly lower than those in the control group （P 〈 0.05 ）. Conclusion Low tidal volume mechanical ventilation treatment has better curative effect for patients with high risk ALI/ARDS, with better prognosis.
出处
《临床肺科杂志》
2016年第4期728-731,共4页
Journal of Clinical Pulmonary Medicine
关键词
机械通气
急性肺损伤
急性呼吸窘迫综合症
小潮气量通气
mechanical ventilation
acute lung injury
acute respiratory distress syndrome
low tidal volume ventilation
