不同潮气量机械通气对创伤后急性呼吸窘迫综合征疗效的影响

目的探讨小潮气量(LTV)加呼气末正压(PEEP)机械通气(MV)治疗创伤后急性呼吸窘迫综合征(ARDS)的疗效。方法以18例常规潮气量(8～12ml/kg)MV为对照组,20例小潮气量(5～7ml/kg)加用PEEP的MV模式为观察组,比较两组间血气,RR、HR、MAP、CVP、呼吸机所致肺损伤(VILI)、多脏器功能不全(MODS)发生率及ARDS病死率。结果两组PaO2差异无显著性意义(P>0.05);观察组PaCO2高于对照组(P<0.05);观察组无VILI、MODS及死亡病例发生,对照组2例VILI、2例ARDS并发MODS死亡。结论在ARDS治疗中采用小潮气量加PEEP及允许范围内高碳酸血症(PHC)的保护性通气策略,可明显改善缺氧,减少VILI发生,从而降低其病死率。

Effect of Ventilation with Different Tidal Volumes for Post-traumatic Acute Respiratory Distress Syndrome

Objective To compare the effect of mechanical ventilation (MV) with lower tidal volumes (LTV) plus positive end-expiratory pressure (PEEP) versus conventional tidal volumes (CTV) in the treatment of post-traumatic acute respiratory distress syndrome (ARDS).Methods From Nov. 1999 to Dec. 2002, 18 cases of post-traumatic ARDS were treated with conventional MV using 8-12 ml/kg of tidal volume (control group); From Jan. 2003 to Oct. 2004, 20 cases of post-traumatic ARDS were treated with low tidal volume (5-7 ml/kg) plus PEEP MV (observation group). A comparison was made upon blood gas, RR, HR, MAP, CVP, incidence of ventilation-induced lung injury (VILI), incidence of multiple organ dysfunction syndrome (MODS) as well as mortality of ARDS. Results There was no statistically significant difference in PaO_2 and hemodynamic indexes between two groups (P>0.05), while PaCO_2 in observation group was higher than in control group (P<0.05). No VILI, MODS and death occurred in observation group, while in control group, there were 2 cases of VILI and 2 cases of ARDS with MODS.Conclusion Protective MV with LTV plus PEEP and permissive hypercapnia (PHC) can attain the same effect of oxygen saturation as conventional MV and reduce the VILI and the mortality of ARDS.