适应性支持通气和压力控制通气在重症创伤性湿肺通气策略中的比较

目的：比较重症创伤性湿肺（STWL）时实行肺保护通气策略中,适应性支持通气（ASV）和压力控制通气（PCV）模式对患者呼吸力学、血气及血流动力学的影响,并探讨其临床意义。方法：78例STWL患者随机分为ASV组和PCV组进行机械通气治疗,均实行肺保护通气策略,比较两组患者呼吸力学、血气及血流动力学各指标的变化,以及1周内使用镇静剂的用量及脱机时间。结果：ASV组通气24h气道峰压和平均气道压均低于PCV组;两组通气24h后中心静脉压均升高,而PCV组升高更明显;两组治疗后心率显著减慢,ASV组更明显;两组同时间点平均动脉压比较,差异无统计学意义（P〉0.05）;两组均未发生气压伤;两组治疗24h后PaO2、PaO2/FiO2较治疗前均明显升高。ASV组24h后PaCO2明显下降,1周内使用镇静剂剂量小于PCV组,脱机时间缩短,住ICU时间相应减少。结论：对于STWL患者在实行肺保护通气策略时,ASV和PCV通气模式均可改善氧合,防止气压伤的发生,对患者血流动力学影响小,ASV模式控制气道峰压及平均气道压更有效,能减少镇静剂的用量,缩短机械通气时间。主张对于STWL患者尽量采用ASV模式实行肺保护通气策略。

Comparison of severe traumatic wet lung using adaptive support and pressure controlled ventilation with ventilation strategies

Objective：To compare the effect of ASV and PCV ventilation modes on STWL in respiratory mechanics,blood gas and hemodynaics,when the implementation of lung protective ventilation strategy,and explore their clinical significances. Methods：78 STWL patients were randomly divided into ASV group and PCV group and treated with mechanical ventilation,all with lung protective ventilation strategies,then compared the variation in respiratory mechanics,blood gas hemodynamics,the dosage of sedative drugs within a week and the time off-ventilation. Results：The peak airway pressure （Ppeak） and mean airway pressure （Pmean） of ASV group were lower than those of the PCV group with 24 hours＇ ventilation,after 24 hours＇ ventilation,the central venous pressure （CVP） of two groups was higher,but more higher in PCV group; the heart rate of two groups slowed down after the treatment,ASV group was more obvious; the mean arterial pressure of two groups at the same time showed no significant difference （P0.05）; there was no pulmonary barotrauma in two groups; after 24 hours＇ treatment,PaO2 and PaO2/FiO2 of two groups were dramatically higher than those before treatment,ASV group was more obvious. ASV group used less sedative drugs than PCV group in a week,PaCO2 of ASV group decreased significantly after 24 hours. The time off-ventilation and stay time in ICU were reduced. Conclusion：When STWL patients with the implementation of lung protective ventilation strategy,ASV and PCV ventilation modes can improve patients＇ oxygenation,prevent the occurrence of barotrauma and impact on the hemodynamics. ASV mode can control Ppeak and Pmean more efficient,also can reduce the use of sedative drugs and shorten the duration of mechanical ventilation effectively. Consequently,when putting to use lung protective ventilation strategy,we advocates for implementing ASV ventilation modes on STWL patients as possible as we can.