保护性机械通气治疗严重肺挫伤的疗效评价

目的 研究保护性机械通气治疗严重肺挫伤的临床效果.方法 将53例严重肺挫伤患者按住院日期单双数随机分为两组:保护性通气组25例,潮气量6-8 ml/kg,传统通气组28例,潮气量12-15 ml/kg,其他呼吸机参数按同一策略调整.观察机械通气治疗前后血气参数的变化,比较两组呼吸机使用时间、病死率及并发症的发生率.结果 两组患者机械通气后动脉血氧分压、氧合指数均明显改善,两组比较差异无统计学意义.保护性通气组呼吸机使用时间(149.8±77.3)h,死亡7例(28.0%),传统通气组呼吸机使用时间(203.3±85.2)h,死亡11例(39.3%),两组呼吸机使用时间和病死率比较差异有统计学意义(P＜0.01).且保护性通气组并发肺部感染、气胸,纵隔气肿的发生率均低于传统通气组(P＜0.05),急性呼吸窘迫综合征的发生率虽低于传统通气组,但差异无统计学意义(P＞0.05).结论 保护性机械通气可有效改善严重肺挫伤患者的肺氧合功能,提高动脉血氧分压,显著缩短呼吸机使用时间,降低病死率和呼吸机相关并发症的发生率,改善预后,值得临床推广.

The study of protective ventilation strategy on severe pulmonary contusion

Objective To investigate the effect of protective ventilation strategy on severe plumonary contusion. Methods Fifty-three patients suffered from severe pulmonary contusion were randomly divided into the protective ventilation group (25 cases,the tidal volume was 6-8 ml/kg) and the traditional ventilation group (28 cases,the tidal volume was 12-15 ml/kg). The blood gases were examined before and after ventilation. Moreover,the time for ventilation therapy,mortality rate and morbidity of complications were compared between the two groups. Results After ventilation,arterial oxygen content and oxygenation index were improved obviously in two groups,and there was no significant difference between the two groups. Average time for ventilation therapy and mortality rate in the protective ventilation group were (149.8 ±77.3) h and 28.0%(7/25),and those in the traditional ventilation group were (203.3 ± 85.2) h and 39.3% (11/28),there were significant difference between the two groups (P ＜0.01). The morbidity of pulmonary infection,pneumothorax and mediastinal emphysema in the protective ventilation group were significantly lower than those in the traditional ventilation group(P＜ 0.05 ). The morbidity of acute respiratory distress syndrome (ARDS) was no significant difference between the two groups (P ＞0.05). Conclusion Protective ventilation therapy for severe pulmonary contusion can effectively improve the pulmonary oxygenation function,increase arterial oxygen content,and markedly reduce the time for ventilation therapy,mortality rate,and morbidity of ventlation-associated complications.