小潮气量机械通气治疗老年重症肺炎呼吸衰竭患者效果观察  

Application study on low tidal volume mechanical ventilation in elderly patients with severe pneumonia and respiratory failure

作　　者：廖鑫燕[1] 

机构地区：[1]天津医科大学,天津300070

出　　处：《河北联合大学学报（医学版）》2013年第6期757-759,共3页Journal of North China Coal Medical College

摘　　要：①目的比较小潮气量和传统潮气量机械通气在老年重症肺炎合并呼吸衰竭患者中的疗效和安全。②方法将收治的年龄>60岁重症肺炎合并呼吸衰竭患者随机分为两组,小潮气量通气组(A组)和传统潮气量通气组(B组),每组各30例。小潮气量通气组(A组)采用小潮气量,VT 6～8mL/kg;传统潮气量通气组(B组)的潮气量VT 10～12mL/kg。分别于气管插管前、机械通气1 h、机械通气2h记录各时点的动脉血气分析、气道平台压(Pplat)、平均动脉压(MAP)、心输出量(CI)、胸腔内血容积指数(ITBI)等指标。并对两组患者的相关并发症及预后进行比较分析。③结果机械通气1h、机械通气2h时两组的氧合指数无统计学差异(P>0.05),各时点小潮气量通气组的Pplat均低于B组,呼吸系统静态顺应性(Cst)均高于B组,差异有统计学意义(P<0.05);A组的MAP、胸腔内血容积指数(ITBVI)、心输出量(CI)在不同时点无明显变化,差异无统计学意义(P>0.05),B组患者机械通气后MAP、胸腔内血容积指数(ITBI)较机械通气前下降,差异有统计学意义(P<0.05)。④结论采用小潮气量的肺保护性机械通气策略,可以达到很好的机械通气效果。呼吸机相关肺损伤发生率低,对血液动力学影响较小,对老年呼吸衰竭患者带来更多的益处。Ojeetive To investigate the difference of low tidal volume and conventional tidal volume mechanical ventilation in elderly patients with severe pneumonia complicated respiratory failure. Methods The 60 elderly patients with severe pneumonia and respiratory ＇failure were stratified according to tidal volume （VT） 1 evels. The low tidal volume mechanical ventilation （ VT 6 - 8mL/kg） and conventional tidal volume mechanical ventilation group（ VT 10 - 12mL/kg） had 30 subjects separately. The levels of PaO2 ,PaCO2 ,Pplat,MAP ,CI and ITBVI were measured. Also compare the related complications and prognosis of the two groups. Results The Oxygen index had no statistical difference in different ventilation times（ P 〉 0.05）. Compared with the conventional tidal volume mechanical ventilation group,the Pplat in the low tidal volume mechanical ventilation group was significantly lower（ P 〈0.05）, while the respiratory system static compliance was significantly higher（ P 〈0.05）. The MAP,ITBVI and CI had no sta- tistical difference in the low tidal volume mechanical ventilation group at different ventilation times （ P 〉 0.05 ）, while in the conven- tional tidal volume mechanical ventilation group the levels of MAP,ITBVI and CI were gradually decreased with the increase of venti- lation time. The patients in the low tidal volume mechanical ventilation group had no atelectasis and pneumothorax happened, and the ventilation time was shorter, while the success rate was higher. Conclusion Compared with conventional mechanical ventilation, The low tidal volume of lung protective mechanical ventilation can achieve very good mechanical ventilation effect, Ventilator - Associated Lung Injury occurred less and less influence on hemodynamicso So, The low tidal volume of lung protective mechanical ventilation bring more benefits for elderly patients with respiratory failure.

关 键 词：小潮气量 机械通气 重症肺炎 老年 

分 类 号：R54[医药卫生—心血管疾病]