肺复张手法与单纯小潮气量机械通气治疗急性呼吸窘迫综合征

目的观察肺复张手法对急性呼吸窘迫综合征（ARDS）患者的治疗作用，并与小潮气量辅助／控制通气方式比较。方法20例ARDS患者，平均年龄（58±8）岁。分为两组：（1）试验组10例：采用肺复张手法机械通气；（2）对照组10例：采用小潮气量辅助／控制通气（潮气量设为6ml／kg，体重为标准体重）。分别观察两组患者上机后0、48和72h的氧合指数、中心静脉压、镇静药物的用量以及28d的病死率和并发症等。结果试验组与对照组比较，氧合指数48h分别为（297±15）及（211±12）cmH20，72h为（305±18）及（247±16）cmH2O；带机时间缩短为（15±2）及（21±2）d；48h中心静脉压分别为（14．1±0．5）及（19．2±1．0）cmH2O，72h分别为（11．3±0．8）及（17．1±1．1）cmH2O。28d病死率和并发症的发生率两组比较差异无统计学意义（P〉0．05）。结论肺复张手法比单纯小潮气量容量控制／辅助通气具有改善氧合迅速、带机时间短、血流动力学稳定及所用镇静药物少等优点。

Comparison of recruitment maneuvers and low tidal Volume A/C ventilation in patients with acute respiratory distress syndrome

Objective To observe the effects of mechanical ventilation combined lung recruitment maneuvers （LRM） with low tidal volume A/C ventilation in patients with acute respiratory distress syndrome （ARDS）. Methods A prospective, randomized comparison of mechanical ventilation combined with lung recruitment maneuvers （the test group） with low tidal volume A/C ventilation （the control group） was conducted in 20 patients with ARDS. FiO2/PaO2 ratios, and central venous pressure （CVP）. Durations of ventilation support were recorded at 0h, 48h and 72 h separately, and the ventilation associated with lung injury and mortality at 28 d were also recorded. Results The FiO2/PaO2 ratios were （297±15 ） and （305±18） cm H2O, CVP were （19.2±1.0） and （ 17. 1±1.1 ） cm H2O. The results were better in the test group as compared with the control group （ all P 〈0.01 ）. The duration of ventilation support in the test group was shorter than in the control group. The mortality in 28d and ventilation associated lung injury were similar in the two groups. Conclusion The results show that combination of LRM mechanical ventilation, as compared with the control group, contributes to improved FiO2/PaO2 ratio, stable homodynamic and shorter duration of ventilation support in patients with ARDS.