机械通气治疗策略变化的单中心研究  被引量:2

The change in strategy of mechanical ventilation : a single center study in China

在线阅读下载全文

作  者:马玲[1] 姜利[1] 席修明[1] 

机构地区:[1]首都医科大学附属复兴医院ICU,北京100045

出  处:《中国危重病急救医学》2011年第9期524-529,共6页Chinese Critical Care Medicine

基  金:首都医学发展科研基金资助项目(2007-1042)

摘  要:目的观察一个单医疗中心机械通气(MV)治疗策略的变化。方法调查1994年1月至1997年12月(对照组)以及2004年1月至2006年12月(研究组)两个时间段人住首都医科大学附属复兴医院重症监护病房(ICU)且行MV超过24h的502例患者的临床资料。收集的主要数据包括MV的病因、MV模式、呼吸机治疗参数、脱机方法及患者的预后。结果ICU中MV使用率为46.1%(502/1090),其中对照组48.9%(184/376),研究组44.5%(318/714)。502例患者中接受MV的主要原因为:肺炎18.3%(92例),慢性阻塞性肺疾病急性加重(AECOPD)16.3%(82例),昏迷14.1%(71例),术后13.7%(69例),急性呼吸窘迫综合征(ARDs)12.7%(64例)。初始设定MV模式:对照组59.8%(110/184)为辅助/控制通气(A/C),20.7%(38/184)为压力支持通气(PsV);研究组23.0H(73/318)为A/c,57.2%(182/318)为PSV,两组差异有统计学意义(均P〈O.01);研究组无创正压通气(NPPV)的使用率较对照组明显增加510.4%(33/318)比3.8%(7/184),P〈0.013;两组患者压力支持(PS)的平均值均为14cmH。O(1cmH。O=0.098kPa),呼气末正压(PEEP)平均值均为5.0cmH。O;与对照组比较,研究组中ARDS患者PEEP水平(cm H2O)明显升高(8.0比6.0,P〈0.01),潮气量(Vr,ml)明显减小(400比550,P〈0.01)。两组常用脱机方法为T管、T管+PSV、PSV3种,与对照组比较,研究组T管的使用明显增加[84.4%(184/218)比35.1%(40/114),P〈0.01],PSV使用明显减少(2.8%(6/218)比29.8%(34/114),P〈0.013。两组MV患者的总体ICU病死率为49.6%(249/502),校正后研究组与对照组的ICU病死率比较差异无统计学意义(54.6%比55.4%,P=0.887)。结论单中心MV治疗策略10年来发生了一些�Objective To observe the treatment strategy and its changes in mechanical ventilation (MV) in a single medical center. Methods Five hundred and two patients undergoing MV for at least 24 hours from January 1994 to December 1997 (control group) and from January 2004 to December 2006 (study group) in a total of 1 090 patients who were admitted to intensive care unit (ICU) Fuxing Hospital, Capital Medical University during the 2 periods were investigated. Datas including causes for the initiation of MV, ventilator modes and treatment parameters, weaning methods, and prognosis of patients were collected. Results The total incidence of MV was 46.1% (502/1 090). The incidence of MV in control group was 48.9% (184/376), and that in study group was 44.5% (318/714), respectively. The main causes for MV of 502 patients were pneumonia 18.3% (92 cases), acute exacerbation of chronic obstructive pulmonary disease (AECOPD) 16.3% (82 cases), postoperation 13.7% (69 cases), coma 14.1% (71 cases), and acute respiratory distress syndrome (ARDS) 12.7% (64 cases). The initial ventilator mode: 59.8% (110/184) or 23.0% (73/318) in control or study group was assist/control ventilation (A/C), and 57.2% (182/318) or 20. 7% (38/184) in study or control group was pressure support ventilation (PSV), and there was significant difference between the two groups (both P〈0. 01). The use of noninvasive ventilation (NPPV) in study group was obviously increased compared with control group (10.4% (33/318) vs. 3.8% (7/184), P〈0.01). The mean pressure level of pressure support (PS) of all patients was 14.0 cm H2O (1 cm H2O= 0. 098 kPa), the mean positive end-expiratory pressure (PEEP) of both groups was 5.0 em H2O. Compared with control group, PEEP (cm H2O) level in patients with ARDS was significantly higher (8.0 vs. 6.0, P〈0.01) and volume tidal (VT, ml) was significantly lower (400 vs. 550, P〈0.01) in study group

关 键 词:机械通气 治疗策略 重症监护病房 变化 

分 类 号:R563.8[医药卫生—呼吸系统]

 

参考文献:

正在载入数据...

 

二级参考文献:

正在载入数据...

 

耦合文献:

正在载入数据...

 

引证文献:

正在载入数据...

 

二级引证文献:

正在载入数据...

 

同被引文献:

正在载入数据...

 

相关期刊文献:

正在载入数据...

相关的主题
相关的作者对象
相关的机构对象