胸外伤并发急性呼吸窘迫综合征的高危因素分析和应用低潮气量+PEEP机械通气治疗的研究  

Clinical study on the risk factor and mechanical ventilation with low volume plus positive end-expiratory pressure in treatment of pulmonary injury complicated with acute respiratory distress syndrome

作　　者：詹毓彦[1] 王金栋[1] 张东升[1] 

机构地区：[1]河北省石家庄市第三医院胸外科,050011

出　　处：《河北医药》2007年第11期1180-1183,共4页Hebei Medical Journal

摘　　要：目的探讨引起急性呼吸窘迫综合征(ARDS)的高危因素以及低潮气量的PEEP机械通气模式治疗创伤性ARDS的疗效。方法选取胸外伤为主的全身多发伤患者538例,损伤严重程度根据AIS90-ISS定级标准进行评分。分析与ARDS相关的因素以此判断对病情发展趋势的影响。将确诊后ARDS患者随机分为A、B2组,采用不同通气方式进行治疗,在机械通气2、12、24、48h观察患者血气指标、呼吸机相关肺炎(VAP)发生率、呼吸机所致肺损伤(VILI)和多器官功能不全综合征(MODS)的发生时间、发生率。结果(1)胸外伤后呼吸、血压、血气异常,合并肋骨骨折、肺挫伤、血气胸、腹腔内脏损伤、四肢或骨盆骨折、慢性阻塞性肺病,ARDS发病率均明显增高(P均<0.01);ISS≥16时,ARDS发病率明显增高(P<0.01)。(2)A、B2组SaO2、PaO2差异均无统计学意义(P均>0.05),而PaCO2B组明显高于A组,(P<0.01);B组VILI发生率明显低于A组(P<0.01);B组VAP发生率明显低于A组(P<0.01);A组MODS发生率和B组比较差异无统计学意义(P均>0.05);B组MODS发生时间较A组明显延迟(P<0.01)。结论(1)高龄、休克、呼吸困难、多发肋骨骨折、肺挫伤,大量血气胸、腹腔内脏损伤、慢性阻塞性肺病是影响胸外伤并发ARDS的高危因素。(2)低潮气量+PEEP机械通气适合ARDS患者应用。Objective To investigate the risk factors of acute respiratory distress syndrome（ARDS） and the therapeutic effect of mechanical ventilation with low volume pins PEEP on ARDS. Methods 538 patients with severe thoracic trauma were selected in this study. There were 455 male and 103 female with the moan age 52 years. The injured degree was evaluated according to AIS90-ISS grade. The factors correlated to ARDS were analyzed to assess the influence on tendency of ARDS. There were 31 patients who were diagnosed as ARDS. The convention ventilation and ventilation with low volume ＋ PEEP mode were performed in these patients. The parameters of blood gas, the incidence of ventilator associated pneumonia （VAP） and ventilation inducing hmg injury （VILI）, the attack time and incidence of multi-organ dysfunction syndrome （MODS） were observed. Results （1）The incidence of ARDS＇ obviously increased when the parameters of respiration, blood pressure and blood-gas were abnormal（ P 〈 0.01 ）, and when which were complicated with rib fracture, pulmonary contuse, hemopneumothorax, injury of abdomen organs, extremity or pelvis fracture and chronic obstructive pulmonary disease, the incidence of ARDS increased significantly （P 〈 0.01） . 2. In 31 patients with ARDS, there was no significantly difference in SaO2 and PaO2 between group A and group B（ P 〉 0.05）, however, PaCO2 in group B was significantly higher than that in group A （ P 〈 0.01 ）. The incidence of VILI and VAP in group B was also lower than that in group A （ P 〈 0.01）. There was no significantly difference in incidence of MODS between group A and group B （ P 〉 0.05）. It was easier for group B than group A to postpotne he attack time of MODS （ P 〈 0.05）. Conclusion （ 1 ） High age, shock, dyspnea, multi-fracture of rib, pulmonary contuse, severe hemopneumothorax, injury of abdomen organs, complications of respiratory system and levels of ISS are high risk factors influencing ARDS after thoracic trauma. （2�

关 键 词：成人急性呼吸窘迫综合征 胸外伤 高危因素 机械通气 低潮气量 

分 类 号：R563.8[医药卫生—呼吸系统]