肺保护性通气策略在肺结核毁损肺机械通气中运用的研究  

Clinical application and research on lung-protective mechanical ventilation strategies for destructive pneumonophthisis

作　　者：刘智[1] 雷琳[1] 李剑[1] 杨梁梓[1] 柯学[1] 傅佳鹏[1] 刘志超[1] 傅向东[1] 李国保[1] 

机构地区：[1]深圳市第三人民医院肺三科,广东深圳518112

出　　处：《临床肺科杂志》2017年第8期1493-1496,共4页Journal of Clinical Pulmonary Medicine

基　　金：广东省医学科学技术研究基金项目(No B2015015)

摘　　要：目的探讨肺保护性通气策略在结核性毁损肺机械通气治疗中的应用价值及其对患者预后的影响。方法选取86例行机械通气治疗的结核性毁损肺患者为研究对象,用随机数字表法分为研究组(n=43)和对照组(n=43)。研究组予以肺保护性通气策略下机械通气疗法[潮气量为6-8m L/kg,呼气末正压通气(PEEP)为5-9cm H_2O],对照组予以常规机械通气疗法(潮气量为10-12m L/kg,PEEP为0-4cm H_2O)。观察对比两组受试者通气前后血气指标变化情况,并比较二者平均通气时间、肺气压伤发生率、呼吸机相关性肺炎发生率、死亡率差异。结果通气后,两组患者PaCO_2水平均较通气前显著降低,两组患者PH值水平、氧合指数与PaO_2水平则较通气前显著提升,差异均有统计学意义(P<0.05);且组间比较差异亦有统计学意义(P<0.05)。研究组平均通气时间显著短于对照组,差异有统计学意义(P<0.05)。两组通气后死亡率比较,差异无统计学意义(P>0.05);研究组肺气压伤发生率显著低于对照组,差异有统计学意义(P<0.05);研究组呼吸机相关性肺炎发生率显著低于对照组,差异有统计学意义(P<0.05)。结论本研究发现肺保护性通气策略在改善肺结核毁损肺患者机械通气治疗效果,降低肺气压伤及呼吸机相关性肺炎发生率,缩短上机时间等方面优于常规通气策略,值得临床应用和推广。Objective To investigate the application and prognosis of lung-protective mechanical ventilation strategies for destructive pneumonophthisis patients.Methods 86 destructive pneumonophthisis patients who were all treated by mechanical ventilation were selected and divided randomly into the study group （n=43） and the control group （n=43）.Lung-protective strategies were used in the study group [tidal volume was 5-8 mL/kg, positive end-expiratory pressure （PEEP） was 5-9 cmH2O], while conventional mechanical ventilation （tidal volume was 10-12 mL/kg, PEEP was 0-4cmH2O） was used in the control group.The parameter changes of blood gas analysis were observed before and after ventilation.The differences in the average duration of ventilation, mortality, incidence rates of pulmonary barotrauma and ventilator associated pneumonia （VAP） were compared.Results PH level, oxygenation index and PaO2 were higher, while PaCO2 level was significantly lower than before ventilation in the two groups （P〈0.05）, and the difference was statistically significant between the two groups （P〈0.05）.The average duration of ventilation of the study group was significantly shorter than that of the control group （P〈0.05）.There was no significant difference in mortality between the two groups after ventilation （P〉0.05）.The incidence of pulmonary barotrauma and VAP were significantly lower in the study group than in the control group （P〈0.05）.Conclusion Lung protective ventilation is more worthy of clinical application and promotion than conventional ventilation strategy in improving the effectiveness, reducing the incidence of pulmonary barotrauma and ventilator associated pneumonia, and shortening the average duration of ventilation.

关 键 词：结核性毁损肺 机械通气 肺保护策略 PEEP 潮气量 

分 类 号：R521[医药卫生—内科学]