不同机械通气模式治疗老年人重症胸部损伤合并急性呼吸窘迫综合征的效果观察  

Effects of different mechanical ventilation modes on severe chest injury complicated with acute respiratory distress syndrome in elderly patients

作　　者：卢微 Lu Wei(Department of ICU, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou, Zhejiang 312400, China)

机构地区：[1]嵊州市中医院ICU,浙江省312400

出　　处：《中国基层医药》2019年第15期1854-1857,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省医药卫生科技计划项目(2014KYB292).

摘　　要：目的观察不同机械通气模式治疗老年人重症胸部损伤合并急性呼吸窘迫综合征的效果。方法选择嵊州市中医院2016年7月至2018年7月治疗的老年人重症胸部损伤合并急性呼吸窘迫综合征患者92例为研究对象,采用信封式分组的方法将患者分为对照组和观察组,每组46例。对照组患者接受同步间歇性指令通气联合呼气末正压通气治疗,观察组患者给予连续性气道正压通气联合压力支持通气治疗。观察两组的临床疗效、呼吸模式参数和血气指标。结果观察组临床总改善率(97.83%)与对照组(93.48%)差异无统计学意义(χ^2=0.426,P>0.05);观察组通气量(MV)、氧饱和度(SaO2)和氧分压(PaO2)均明显高于对照组,吸气末峰压(PIP)、二氧化碳分压(PaCO2)均明显低于对照组(t=13.022、18.622、10.605、27.238、11.746,均P<0.05);观察组患者的各项血气指标均明显优于对照组(t=6.166、2.766、6.905,均P<0.05)。结论同步间歇性指令通气联合呼气末正压通气与连续性气道正压通气联合压力支持通气治疗老年人重症胸部损伤合并急性呼吸窘迫综合征均可获得理想的临床疗效。Objective To investigate and analyze the effect of different mechanical ventilation modes in the treatment of severe chest injury complicated with acute respiratory distress syndrome in the elderly. Methods From July 2016 to July 2018, 92 elderly patients with severe chest injury complicated with acute respiratory distress syndrome who were treated in Shengzhou Hospital of Traditional Chinese Medicine were selected in the research.The patients were divided into control group and observation group by envelope-type grouping, with 46 cases in each group.The control group received synchronous intermittent command ventilation combined with positive end-expiratory pressure ventilation, and the observation group was given continuous positive airway pressure ventilation combined with pressure support ventilation.The clinical efficacy, respiratory pattern parameters and blood gas indicators of the two groups were compared. Results The total clinical improvement rate of the observation group was 97.83%, which of the control group was 93.48%, the difference was not statistically significant (χ^2=0.426, P>0.05). The MV, SaO2 and PaO2 in the observation group were significantly higher than those in the control group, while PIP and PaCO2 in the observation group were significantly lower than those in the control group, the differences were statistically significant (t=13.022, 18.622, 10.605, 27.238, 11.746, all P<0.05). All the blood and gas indicators in the observation group were significantly better than those in the control group (t=6.166, 2.766, 6.905, all P<0.05). Conclusion Synchronous intermittent command ventilation combined with positive end-expiratory pressure ventilation and continuous positive airway pressure combined with pressure support ventilation in the treatment of elderly patients with severe chest injury combined with acute respiratory distress syndrome can achieve an ideal clinical effect.

关 键 词：通气机 机械 呼吸 人工 呼吸窘迫综合征 成人 胸部损伤 血气分析 老年人 

分 类 号：R655[医药卫生—外科学] R563.8[医药卫生—临床医学]