小潮气量通气对创伤性ARDS的疗效分析

目的：探讨小潮气量通气对创伤性ARDS的疗效。方法：回顾性分析48例创伤性ARDS患者的病历资料，分为两组，大潮气量组23例，VT10～12ml／kg理想体重，PEEP5～10cmH2O，平台压35-50cmH2O；小潮气量组25例，VT5～8ml／kg理想体重，PEEP10～15cmH20，平台压≤35cmH2O。观察两组通气治疗前、后3dPaO2／FiO2、PaCO2、pH值及气压伤的发生情况和ICU住院期间病死率。结果：通气治疗后两组PaO2／FiO2均较通气治疗前明显升高（P〈0．05，P〈0．01），但在第3天，小潮气量组PaO2／FiO2明显低于大潮气量组（P〈0．01）；小潮气量组出现明显高碳酸血症，但在机体可耐受范围。大潮气量组出现3例气压伤，小潮气量组无气压伤发生。小潮气量组病死率16％（4／25）低于大潮气量组26．08％（6／23）（P〉0．05）。结论：小潮气量通气可改善创伤性ARDS患者氧合状态和预后，减少呼吸机相关性肺损伤的发生。

Analysis of Efficacy of Low Tidal Volume Ventilation in Traumatic Patients With ARDS

Objective： To explore the efficacy of low tidal volume （VT）ventilation in traumatic patients with acute respiratory distress syndrome（ARDS）. Methods： Clinical data of 48 traumatic patients with ARDS were analyzed retrospectively and divided into two groups： high VT group （ 23 cases） ventilated with VT 10-12 ml/kg ideal body weight （IBW）, positive end expiratory pressure（PEEP）5- 10 cmH2O, inspiratory plateau pressure 35 - 50 cmH2O, low VT group （25 cases） ventilated with VT5-8 ml/kg IBW, PEEP 10-15 cmH2O, inspiratory plateau pressure≤35 cmH2O. PaO2/FiO2 ratio, PaCO2, pH value, barotrauma and ICU mortality were observed before ventilation and three days after ventilation. Results： After ventilation, PaO2/FiO2 ratio of two groups was significantly higher than that before ventilation, but in the third day of ventilation, the PaO2/Fi02 ratio of low VT group was lower than that in high VT group（P〈0. 01）, and there was obvious hypercapnia in low VT group, but the hypercapnia was well tolerated by patients. Barotrauma occured in 3 patients of high VT group, but patients in low V-T group have no barotrauma. The mortality of low VT group 16% （4/25） was lower than that of high VT group 26. 08% （6/23）, but there was no significantly difference （P〉0. 05）. Conclusion： Low tidal volume ventilation could improve oxygenation and clinical outcome and reduce ventilator induced lung injury in traumatic patients with ARDS.