保护性通气策略对重度有机磷中毒患者肺部并发症的影响

目的 探讨急性重度有机磷农药中毒患者实施小潮气量联合肺复张机械通气策略对肺部并发症的影响。方法 选择重度敌敌畏中毒患者48例,均存在呼吸衰竭行机械通气治疗,随机分为保护性通气组和常规通气组,每组各24例,均给予对症解毒等药物治疗。常规通气组实施10 mL/kg理想体质量和呼气末正压(positive end-expiratory pressure, PEEP)通气3 cmH₂O,保护性通气组给予6 mL/kg理想体质量和PEEP 6 cmH₂O,并给予每日2次肺复张。观察通气24 h和通气72 h后血气指标、肺部感染指标(肺部感染评分、C反应蛋白、降钙素原)、肺不张发生情况。结果 机械通气24 h和72 h后,保护性通气组肺部感染指标低于常规通气组,差异有统计学意义(P<0.05);保护性通气组氧分压和氧合指数高于常规组,差异有统计学意义(P<0.05);2组之间肺不张发生率差异无统计学意义(P>0.05)。结论 保护性通气策略能够降低急性重度有机磷农药中毒患者肺部感染发生风险,改善氧合,但并不能减少肺不张的发生。

Effect of protective ventilation strategy on pulmonary complications in patients with severe organophosphorus pesticide poisoning

Objective To explore the effects of low tidal volume mechanical ventilation combined with lung recruitment maneuver in patients with acute severe organophosphorus pesticide poisoning.Methods Analysis of 48 cases with acute severe dichlorphos poisoning, all patients were treated with mechanical ventilation because of respiratory failure.These patient were randomly assigned to the standard ventilation group and the protective ventilation group with 24 cases in each group. The patients of the standard ventilation group were received a tidal volume of 10 mL/kg ideal body weight and 3 cmH₂O positive end-expiratory pressure. The patients of the protective ventilation group were received a tidal volume of 6 mL/kg ideal body weight and 6 cmH₂O positive end-expiratory pressure,and implementing twice lung recruitment maneuver per day.Blood gas analysis parameters. Indicators of pulmonary infection(clinicalpulmonary infection scoreCPIS, C-reactive protein CRP, procalcitonin PCT)and atelectasis were recorded after 24 h and 72 h mechanical ventilation. Results After mechanical ventilation 24 h and 72 h, indicators of pulmonary infection in protective ventilation group were significantly lower than that of thestandard ventilation group, the difference was statistically significant(P<0.05). Oxygen partial pressure(PO₂)and oxygenation index in protective ventilation group were significantly higher than that of thestandard ventilation group(P<0.05). There was no significant difference in the incidence of atelectasis between the two groups(P>0.05).Conclusion Protective ventilation strategy can reduce the risk of pulmonary infection and improve oxygenation,but can not reduce the occurrence of atelectasis in patients with acute severe organophosphorus pesticide poisoning.