不同方法机械通气治疗胃肠穿孔后ARDS的效果分析  

Analysis of effects of different mechanical ventilation methods on treatment of ARDS after gastrointestinal perforation

作　　者：许月明[1] 彭春雨[1] 周康华[1] 裴家强[2] 游波[2] 

机构地区：[1]解放军324医院麻醉科,重庆400020 [2]解放军324医院ICU,重庆400020

出　　处：《西南国防医药》2016年第7期742-744,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨不同方法机械通气对胃肠穿孔后脓毒症患者急性呼吸窘迫综合征（ARDS）的治疗效果。方法回顾性分析2002年5月～2013年3月胃肠穿孔后脓毒症的ARDS57例治疗效果。按机械通气方法分为传统潮气量机械通气组fI组）、小潮气量（LTV）加PEEP机械通气组（Ⅱ组）、小潮气量加PEEP结合肺复张法机械通气组（Ⅲ组），比较3组的血气分析、血液动力学指标、气道压、气道阻力、机械通气时间和气胸或纵隔气肿发生率，以及呼吸机相关肺炎与多器官功能障碍综合征（MODS）的发生率及病死率。结果全组死亡15例（26．32％），在机械通气后，各组动脉血pH值、气道阻力无统计学差异（P〉0．05）；24h后，各组血气分析、血液动力学指标均无统计学差异（P〉0．05），但I组气道平台压（Pplat）较Ⅱ、Ⅲ组高（P〈0．05）。I、Ⅱ、Ⅲ组呼吸机治疗时间分别为（159．94±101．54）h、（112．87±64．42）h、（72．64±48．93）h，呼吸机相关肺炎发生率分别为47．06％、40．00％、28．00％，3组间比较均有统计学差异（P〈0．05）。MODS发生率及死亡率3组间无统计学差异（P〉0．05）。结论小潮气量加PEEP结合肺复张的机械通气在治疗胃肠穿孔后ARDS是安全的，肺部并发症减少，但对预后影响不明显。Objective To explore the effects of different mechanical ventilation methods on the treatment of acute respiratory distress syndrome（ARDS） after gastrointestinal perforation in patients with sepsis. Methods A retrospective analysis was made on the effects of ARDS on the treatment of 57 patients who had been suffering sepsis after gastrointestinal perforation and had been admitted in our hospital from May 2002 to March 2013. According to the mechanical ventilation methods, the patients were divided into the group of mechanical ventilation by traditional tidal volume （group I ）, the group of mechanical ventilation by low tidal volume（LTV） ＋ PEEP （group II ） and the group of mechanical ventilation by LTV ＋ PEEP ＋ recruitment maneuver （groupⅢ ）, and the blood gas analysis, hemodynamic index, airway pressure, airway resistance, mechanical ventilation time, the incidence of pneumothorax or mediastinal emphysema, and the incidence and fatality rate of ventilator-associated pneumonia （VAP） and multiple organ dysfunction syndrome （MODS） in the three groups were compared and analyzed. Results A total of 15 patients （26.32%） died; there was no significant among the arterial blood pH and airway resistance in the three groups（P 〉 0.05）; 24 h later, there was no obvious difference among the blood gas analysis and hemodynamic index of the three groups （P 〉 0.05）; however, the Pplat in group I was higher than that in groups II and III（P 〈 0.05）. The ventilator treatment time in the three groups was（159.94-＋101.54）h,（112.87＋-64.42）h and（72.64＋ 48.93）h, respectively; and the incidence of VAP was 47.06%, 40.00% and 28.00%, respectively. There was dramatic difference among the three groups （P 〈 0.05）. There was no statistic difference among the incidence and fatality rate of MODS among the three groups （P 〉 0.05）. Coneltusion The mechanical ventilation by LTV ＋ PEEP ＋ recruitment maneuver is safe in the treatment of ARDS after gastrointestina

关 键 词：小潮气量 肺复张 机械通气 胃肠穿孔 急性呼吸窘迫综合征 

分 类 号：R563.8[医药卫生—呼吸系统]