肺损伤预测评分结合不同潮气量机械通气治疗在非急性呼吸窘迫综合征的急性呼吸衰竭患者中的应用效果  

Application effect of lung injury prediction score combined with mechanical ventilation therapy with different tidal volumes for acute respiratory failure patients with non-acute respiratory distress syndrome

作　　者：吕立文[1] 陈万[1] 唐宇涛[1] 朱良峰[1] 曾希[1] 石磊[1] 

机构地区：[1]广西壮族自治区人民医院急诊科,南宁市530021

出　　处：《广西医学》2017年第6期791-794,共4页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z2013374)

摘　　要：目的探讨肺损伤预测评分(LIPS)结合不同潮气量机械通气治疗在非急性呼吸窘迫综合征(ARDS)的急性呼吸衰竭患者中的应用效果。方法选择需进行有创机械通气治疗的急性呼吸衰竭患者100例,均未达到ARDS的标准,根据患者的LIPS和治疗所需潮气量,将患者分为A组(小潮气量高危组)、B组(小潮气量低危组)、C组(常规潮气量高危组)、D组(常规潮气量低危组),比较机械通气治疗后4组患者的PaO_2、PaCO_2、氧合指数、呼吸力学指标、炎症指标、机械通气时间、住院时间、ARDS发生率、住院28 d内死亡率。结果机械通气治疗48 h后,B组PaO_2、氧合指数高于A组、C组、D组(P<0.05);B组肺顺应性、气道峰压优于A组、C组、D组(P<0.05);B组IL-6、C反应蛋白水平均低于C组、D组(P<0.05);B组机械通气时间、住院时间均少于A组、C组、D组(P<0.05);B组ARDS发生率低于C组及D组(P<0.05)。结论采用LIPS筛选ARDS高危患者,并结合小潮气量机械通气治疗,可改善非ARDS的急性呼吸衰竭患者的临床指标,同时可降低ARDS发生率,提高临床治疗效果。Objective To investigate the application effect of lung injury prediction score（ LIPS） combined with mechanical ventilation therapy with different tidal volumes for acute respiratory failure patients with non-acute respiratory distress syndrome（ non-ARDS）.Methods A total of 100 patients with acute respiratory failure who needed invasive mechanical ventilation treatment were enrolled. All patients did not meet the criterion of ARDS. According to the LIPS and tidal volume for treatment,the patients were divided into Group A（ low tidal volume and high risk group）,Group B（ low tidal volume and low risk group）,Group C（ conventional tidal volume and high risk group） and Group D（ conventional tidal volume and low risk group）. The PaO2,PaCO2,oxygenation index,respiratory mechanics indices,inflammation indices,duration of mechanical ventilation,hospital stay,incidence rate of ARDS and 28-day mortality were compared among the four groups after mechanical ventilation treatment. Results After 48 hours of mechanical ventilation treatment,PaO2 and oxygenation index in Group B were significantly higher than those in Group A,Group C and Group D（ P〈0. 05）. The lung compliance and airway peak pressure in Group B were superior to those in Group A,Group C and Group D（ P〈0. 05）. The levels of IL-6 and C-reactive protein in Group B were lower than those in Group C and Group D（ P〈0. 05）. The duration of mechanical ventilation,and hospital stay in Group B were less than those in Group A,Group C and Group D（ P〈0. 05）. The incidence rate of ARDS in Group B were lower than those in Group C and Group D（ P〈0. 05）. Conclusion For the patients with acute respiratory failure,screening of high-risk ARDS using LIPS combined with low tidal volume mechanical ventilation can improve clinical indices,decrease the incidence rate of ARDS and enhance clinical efficacy.

关 键 词：急性呼吸衰竭 非急性呼吸窘迫综合征 肺损伤预测评分 潮气量 机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]