低潮气量加呼气末正压通气治疗创伤后急性呼吸窘迫综合征的临床研究

目的　探讨低潮气量 (LTV) 呼气末正压 (PEEP)机械通气 (MV)治疗创伤性急性呼吸窘迫综合征 (ARDS)的疗效。　方法　 1997年 10月～ 2 0 0 3年 10月 ,我科 2 6例创伤性ARDS患者 ,分为传统潮气量 (12～ 15ml/kg)机械通气组 (A组 ) 11例 (1997年 10月～ 2 0 0 0年 8月 ) ;低潮气量 (5～ 8ml/kg) PEEP机械通气组 (B组 ) 15例 (2 0 0 0年 9月～ 2 0 0 3年 10月 )。比较两组的血气、血流动力学指标 ,呼吸机所致肺损伤 (VILI)发生率 ,发生多器官功能不全综合征(MODS)的时间、发生率和ARDS的病死率。　结果　两组中血流动力学和血气指标中氧分压(PaO2 )比较 ,差异无显著性意义。B组二氧化碳分压 (PaCO2 )高于A组 (P <0 .0 5 ) ,B组中发生MODS的时间延长 (P <0 .0 5 ) ,MODS的发生率和ARDS的病死率降低且无VILI发生。　结论　低潮气量 PEEP机械通气在创伤性ARDS的治疗中 ,改善氧合与传统方法比较 ,差异无显著性意义 ,PEEP(5～ 18cmH2 O)和轻度高碳酸血症 (PHC)对血流动力学无明显影响 ,且能有效地减少VILI,延长MODS发生的时间 ,适合在ARDS中应用。

Clinical studies of mechanical ventilation with low tidal volume plus positive end-expiratory pressure for post-traumatic acute respiratory distress syndrome

Objective To study the effect of mechanical ventilation (MV) with low tidal volume (LTV) plus positive end-expiratory pressure (PEEP) in treatment of post-traumatic acute respiratory distress syndrome (ARDS). Methods From October 1997 to October 2003, 26 cases of post-traumatic ARDS were treated by conventional MV (Group A, n=11, from October 1997 to August 2000; VT: 12-15 ml/kg) and by MV associated with LTV plus PEEP (Group B, n=15,from September 2000 to October 2003; VT: 5-8 ml/kg). A comparison was made upon blood gas, hemodynamic indices, incidence of ventilation-induced lung injury (VILI), time and incidence of multiple organ dysfunction syndrome (MODS) as well as fatality of ARDS. Results There was no statistically significant difference in PaO 2 of blood gas and hemodynamic indices between both groups, while PaCO 2 in Group B was higher than that in Group A (P<0.05). Furthermore, in Group B, the incidence of MODS and the fatality of ARDS were decreased, with no recurrence of VILI. Latent period for occurrence of MODS in Group B was longer than that in Group A (P<0.05). Conclusions MV with LTV plus PEEP can attain the same effect of oxygen saturation as conventional MV. In the meantime, PEEP (5-18 cm H 2O) and slight hypercapnia is suitable for treatment of post-traumatic ARDS, for they have little influence on hemodynamics, can prevent recurrence of VILI and defer the occurrence of MODS.