呼吸机肺保护性通气治疗老年重症肺炎的临床观察

目的 探讨呼吸机肺保护性通气治疗老年重症肺炎的安全性和临床效果.方法 选择在我院重症医学科治疗的老年重症肺炎患者96例,完全随机化分成A（保护性通气）组 50例;B（正常通气）组46例.A组予保护性机械通气,潮气量设定为6～8 ml/kg;B组行正常机械通气组,潮气量8～12 ml/kg.记录动脉血气分析PaO2、PaCO2、氧合指数.观察记录住院时间、脱管时间、死亡率、治疗7天后观察有效率.结果 A组住院时间、脱管时间较B组明显减少,差异有统计学意义（P＜0.05）.A组有效率较B组明显增加,差异有统计学意义（P＜0.05）.A组治疗7天后PaO2、氧合指数较基础值和B组明显升高,PaCO2较基础值和B组明显降低,差异有统计学意义（P＜0.05）.结论 呼吸机肺保护性通气治疗老年重症肺炎可改善氧合状况,且安全有效.

Clinical observation of lung protective ventilation strategy in the treatment of elderly patients with severe pneumonia

Objective To explore the clinical efficacy and safety of lung protective ventilation in the treatment of elderly patients with severe pneumonia. Methods 96 elderly patients with severe pneumonia from September 2010 to January 2013 were randomly divid- ed into two groups. The group A （50 cases） was treated with protective mechanical ventilation group with the tidal volume of 6 to 8 ml/ kg, and the group B was treated with common mechanical ventilation with the tidal volume of 8 to 12 ml/kg. A comparison was made upon arterial blood gas analysis of PaO2 , PaCO2 , oxygenation index between the two groups, as well as upon duration of hospital stay and extu- bation, mortality and efficiency. Results The duration of hospital stay and extubation was obviously shorter in the group A than in the group B with statistical significance （P 〈 0.05）. The improvement of PaO2 , PaCO2 and oxygenation index was more pronounced in the group A than in the group B （ P 〈 0. 05 ）. Conclusion Mechanical lung protective ventilation is safe and effective in the treatment of eld- erly patients with severe pneumonia, which can improve their oxygenation.