保护性肺通气治疗重症胸部创伤并急性呼吸窘迫综合征52例分析  

Lung protective ventilation strategy in the treatment in severe thoracic trauma patients with acute respiratory distress syndrome

作　　者：罗亦艮[1] 何武剑[1] 刘永利[1] 庞继好[1] 

机构地区：[1]灵山县人民医院胸心外科,广西钦州535400

出　　处：《中国临床新医学》2010年第9期883-886,共4页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

摘　　要：目的探讨重症胸部创伤并发呼吸窘迫综合征(ARDS)机械辅助呼吸治疗的安全有效方法。方法选择52例以重症闭合性胸部创伤为主并ARDS患者,随机分为常规通气组及保护性肺通气治疗组,每组各26例;均以PB760呼吸机辅助呼吸(SIMV+PVS+PEEP模式),分别记录机械通气前及通气后8、24h动脉血气分析PaO_2、PaCO_2及氧合指数(PaO_2/FiO_2);同时记录每组呼吸机辅助呼吸的时间、治疗有效和无效(死亡)例数。结果保护性肺通气组8、24h后氧合指数、PaO_2明显优于常规通气组(P<0.01),呼吸机辅助呼吸时间短于常规通气组(P<0.01),病死率也低于常规通气组(P<0.05)。结论保护性肺通气方式是治疗重症胸部创伤并发ARDS的有效方式。Objective To study the safety and effectiveness of mechanical ventilation in the treatment of severe thoracic trauma patients with acute respiratory distress syndrome. Methods Fifty-two thoracic trauma patients with ARDS were chosen for study. All patients were treated by PB760 breathing machine（ SIMV ＋ PVS ＋ PEEP）. These patients were either treated by regular ventilation mode （ control group, 26 cases） or lung protective ventilation mode （also 26 cases）. Distribution of patients in groups was random. The arterial blood gas indexes including PaO2, PaCO2 and oxygenation index（PaOJFiO2 ） were taken before at 8 h and 24 h respectively and after mechanical ventilation. Each group＇ s time length of assisted respiration and success rate were also recorded for analysis. Results Better oxygenation index and PaO2 at 8 h and 24 h were observed in the lung protective mechanical ventilation group when compared with the control（P 〈0. 01 ）. Time required for mechanical respiration was shorter in lung protective mechanical ventilation group（P 〈0. 01 ）. Mortality rate in the lung protective mechanical ventilation group was lewer than that in control grop （P 〈 0. 05）. Conclusion Lung protective mechanical ventilation is a more effective way in the treatment of severe thoracic trauma patients with ARDS.

关 键 词：重症胸创伤 急性呼吸窘迫综合征 保护性肺通气 机械辅助呼吸 

分 类 号：R655.3[医药卫生—外科学]