围麻醉期急性肺损伤不同干预方法的效果观察

目的 评价不同干预方法对于控制围麻醉期急性肺损伤(ALI)的发生、发展的临床效果及意义.方法 69例在术中确诊为ALI的患者随机分为传统通气治疗组(n=17)、传统通气复合小剂量乌司他丁治疗组(n=24)、肺保护性通气复合大剂量乌司他丁治疗组(n=28),比较三组患者呼吸力学、动脉血气及血流动力学的变化.结果 肺保护性通气复合大剂量乌司他丁治疗组对ALI患者的呼吸力学、动脉血气、肺氧合的改善明显优于其余两组(P＜0.05),并且未发现机械通气相关性肺损伤;其余两组相比较:在呼吸力学、动脉血气、肺氧合变化差异无统计学意义(P＞0.05),两组均发生了机械通气相关性肺损伤;此外,三组在血流动力学的比较差异无统计学意义(P＞0.05).结论 肺保护性通气复合大剂量乌司他丁治疗能有效地改善ALI患者的肺氧合、呼吸力学、动脉血气变化;减少机械通气相关性肺损伤(VILI)的发生;在临床上应该有预见性的应用.

Clinical effects of varies intervention to the aucte lung injury in clinical practice

Objective To evaluate clinical the effects and significance of the occurence and development of varies intervention on control of acute lung injury(ALI)in clinical practice.Methods Sixty-nine ALI patients were randomly divided into three groups:traditional ventilation therapy group(n=17),low dose ulinastatin intervention with traditional ventilation therapy group(n=24)and high dose ulinastatin intervention in lung protective ventilation therapy group(n=28).We compared the changes of pneumodynamics,arterial blood gas and hemodynamics among these groups.Resident time in ICU,time course of mechanical ventilation and mortality of these groups were also compared.Results Large dose ulinastatin intervention in lung protective ventilation therapy group had further improved influence on pneumodynamics,arterial blood gas and puhnonary oxygenation than other groups(P＜0.05)and no mechanical ventilation induced lung injury was found in the group.There were no obvious differences in pneumodynamics,arterial blood gas and pulmonary oxygenation between the other two groups(P＞0.05).Lung injuries induced by mechanical ventilation were all observed in these two groups.There were no obvious differences in hemodynamics among the three groups(P＞0.05).Conclusions Large dose ulinastatin intervention in lung protective ventilation can improve pneumodynamics,arterial blood gas and pulmonary oxygenation of ALI patients.It could decrease the incidence of ventilator induced lung injury(VILI).The treatment should been applied prospectively in clinical practice.