小潮气量联合低平台压在急性呼吸窘迫综合征患者机械通气中的应用  

Efficacy of mechanical ventilations with small tidal volume and low plateau pressure in the treatments of acute respiratory distress syndrome

作　　者：王彦军[1] 赵威[1] 张松涛[1] 贾文元[1] 肖扬[1] 支少敏[1] 房国祥[1] 龚晓亮[1] 尹文[1] WANG Yanjun ZHAO Wei ZHANG Songtao JIA Wenyuan XIAO Yang ZHI Shaomin FANG Guoxiang GONG Xiaoliang YIN Wen(Department of Emergency, Xijing Hospital, The Forth Military Medical University, Xi＇an 710032, China)

机构地区：[1]第四军医大学西京医院急诊科,西安710032

出　　处：《临床急诊杂志》2017年第3期200-203,共4页Journal of Clinical Emergency

摘　　要：目的:探讨小潮气量联合低平台压在急性呼吸窘迫综合征(ARDS)患者机械通气中减少呼吸机相关肺损伤(VILI)的应用。方法:我院急诊科2014~2016年收治的ARDS行机械通气的患者,选取在肺保护性通气策略治疗下测得26cmH_2O≤平台压(Pplat)≤28cmH_2O(1cmH_2O=0.098kPa)共62例,根据机械通气时要求达到的目标平台压的范围不同分为观察组和对照组,观察组38例进一步降低潮气量以达到Pplat 23cmH_2O≤Pplat≤25cmH_2O,TV从(6.4±0.2)ml/kg降到(4.3±0.3)ml/kg(P<0.01)进行机械通气,二氧化碳分压(PaCO_2)从(43.8±9.2)mmHg(1 mmHg=0.133kPa)升高到(76.4±12.6)mmHg(P<0.01)并且pH值从(7.32±0.06)降低到(7.20±0.03)(P<0.01),同时调整呼吸机参数,PEEP按照ARDSnet研究的PEEP设置方法进行设置,呼吸频率最高调整到35次/min,在23cmH_2O≤Pplat≤25cmH_2O同时确保患者脉搏氧饱和度≥90%。72h后检测2组患者的血气分析、氧合指数(PaO_2/FiO_2)、肺泡灌洗液中炎性因子及脱机时间。结果:与对照组相比,观察组患者极低潮气量4ml/kg持续治疗72h后,PaO_2/FiO_2、支气管灌洗液IL-6、IL-8均显著好转,机械通气治疗时间显著降低(P<0.05)。结论:小潮气量联合低平台压在ARDS患者机械通气治疗中减少VILI的发生、改善氧合、减少呼吸机治疗时间方面具有更好的临床效果值得进一步在临床推广应用。Objective：To explore the effects and complications of small tidal volume and low plateau pressure in the treatments of acute respiratory distress syndrome. Method： Forty cases of ARDS were divided into small tidal volume and low plateau pressure group and control group randomly with the equipment of mechanical ventilations. The plateau pressure was kept between 23 and 25 cmH2O,the PCO2 was increased from （43.8±9.2） to （76.4±12.6） ,and tidal volume was decreased from （6.4±0.2） to （4.3±0.3） ml/kg in observation group （P〈0.01）. After 72 h treatments, blood and gas analysis,oxygenation index,inflammatory cytokines in bronchoalveolar lavage fluid and offline time were compared between the two groups, Result：Compared with control group, oxygenation index,IL-6,and IL-8 were significantly improved with lower tidal volume at 4 ml/kg after 72h （P〈0.05）. Mean- while, the treatment with mechanical ventilation was significantly reduced （P〈0.05）. Conclusion： Small tidal vol- ume and low inspiratory plateau pressure can decrease the VILI,improve inspiratory,and reduce treatment time in ARDS. It is valuable for spreading use clinically.

关 键 词：急性呼吸窘迫综合征 机械通气 小潮气量 呼吸机相关性肺损伤 

分 类 号：R563[医药卫生—呼吸系统]