烟雾吸入性肺损伤致急性呼吸窘迫综合征患者应用高频振荡通气的临床价值  

Clinical value of high frequency oscillatory ventilation in patients with ARDS induced by smoke inhalation lung injury

作　　者：杨贤义[1] 刘梅[2] 柴林[1] 肖敏[1] 谢华[3] 

机构地区：[1]湖北医药学院附属太和医院急诊科,湖北十堰442000 [2]湖北医药学院附属太和医院消化内科,湖北十堰442000 [3]湖北医药学院附属太和医院心血管内科,湖北十堰442000

出　　处：《中国临床研究》2017年第8期1022-1025,共4页Chinese Journal of Clinical Research

基　　金：湖北省教育厅科研项目(B2016116)

摘　　要：目的探讨烟雾吸入性肺损伤致急性呼吸窘迫综合征(ARDS)患者应用高频振荡通气临床价值。方法选择2016年1月至2016年12月危重病监护中心接诊的56例烧伤合并烟雾吸入性肺损伤致ARDS患者,随机均分为两组,观察组28例患者给予高频振荡通气,对照组28例患者给予常规机械通气。通过观察两组患者血氧通气各时点血气指标、通气时间及住院时间,比较两组患者并发症和死亡情况。结果两组患者动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)及PaO_2/吸入氧浓度(FiO_2)指标在通气0 h时无统计学差异,观察组患者PaO_2、PaCO_2及PaO_2/FiO_2指标在通气6、24、48、96 h及7 d时明显优于对照组,两组间差异有统计学意义(P<0.05,P<0.01)。观察组患者通气时间(26.6±3.5)d,对照组患者通气时间(31.7±5.7)d,观察组患者住院时间(13.4±1.8)d,对照组患者住院时间(17.7±2.8)d,观察组患者通气时间及住院时间明显短于对照组,差异有统计学意义(P均<0.01)。观察组发生肺炎3例,低血压1例,气压伤1例,其他感染1例,总并发症发生率为21.43%;对照组发生肺炎4例,其他感染1例,总并发症发生率为17.86%;两组总并发症发生率差异无统计学意义(P>0.05)。观察组死亡率为21.43%,对照组死亡率为25.00%,两组死亡率差异无统计学意义(P>0.05)。结论高频振荡通气对烟雾吸入性肺损伤致ARDS患者治疗效果较好,可改善血气指标,减少通气时间及住院时间,但预后没有明显改变。Objective To investigate the clinical value of high frequency oscillatory ventilation（ HFOV） in the treatment of patients with acute respiratory distress syndrome（ ARDS） caused by smoke inhalation lung injury. Methods Fifty-six patients with ARDS caused by burn combined with smoke inhalation lung injury admitted to critical care unit between January 2016 and December 2016 were selected. The patients were randomly divided into observation group and control group（ n = 28,each）. HFOV was adopted in observation group,and conventional mechanical ventilation（ CMV） was adopted in control group. The blood gas indexes at different time points,ventilation time and hospital stay were observed to compare the complications and the condition of death between two groups. Results There were no significant differences in arterial oxygen partial pressure（PaO2）,arterial carbon dioxide partial pressure（PaCO2） and PaO2/fraction of inspired oxygen（FiO2） before mechanical ventilation between two groups（ all P〈0. 05）,but the above indicators at 6-,24-,48-,96-h and 7-day after ventilation in observation group were significantly better than those in control group（ P〈0. 05,P〈0. 01）. The ventilation time[（ 26. 6 ± 3. 5） d vs（ 31. 7 ± 5. 7） d] and hospital stay[（ 13. 4 ± 1. 8） d vs（ 17. 7 ± 2. 8） d] in observation group were all significantly lower than those in control group（ all P〈0. 01）. There were 3 cases of pneumonia,1 case of hypotension,1 case of barotraumas and 1 case of other infections in observation group and 4 cases of pneumonia,1 case of other infections in control group. There were no statistical differences in complication rate（ 21. 43% vs 17. 86%）and mortality rate（ 21. 43% vs 25. 00%） between observation group and control group（ all P〈0. 05）. Conclusion HFOV has better effect on the treatment of ARDS induced by smoke inhalation lung injury and advantages on improving blood gas index,reducing ventilation time and hospital stay,however,the progno

关 键 词：烟雾吸入性肺损伤 急性呼吸窘迫综合征 高频振荡通气 常规机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]