功能残气量导向的机械通气策略在重症肺炎治疗中的应用  

Application of functional residual capacity oriented mechanical ventilation strategy in the treatment of severe pneumonia

作　　者：黎昌[1] 郭伟光[1] 强新华[1] LI Chang;GUO Wei-guang;QIANG Xin-hua(Foshan First People's Hospital,Foshan,Guangdong 528000)

机构地区：[1]佛山市第一人民医院重症医学科,广东佛山528000

出　　处：《赣南医学院学报》2021年第9期924-928,932,共6页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：佛山市自筹经费类科技计划项目(2018AB003111)。

摘　　要：目的:探讨功能残气量(Functional residual capacity,FRC)导向的机械通气策略在重症肺炎治疗中的应用。方法:选取2018年7月至2019年12月入住ICU的重症肺炎机械通气患者94例,应用随机数字表将患者分为观察组及对照组,每组各47例,干预前均采用经验性机械通气治疗策略,对照组采用静态P-V曲线法滴定PEEP,观察组以FRC为导向调整机械通气策略,比较两组干预前后呼吸力学、呼吸氧合力学、血流动力学指标、并发症及预后情况。结果:干预后观察组呼吸力学相关指标(FRC、PEEP、Cst、PIP、Pplat、Pm)、呼吸氧合指标(PaO_(2)、OI、SaO_(2) SvO_(2)、Lac)、血流动力学指标(CI、SVRI、PVPI、EVLWI)较对照组明显改善(P<0.05)。观察组气道出血、气胸、气管插管堵塞或脱落等并发症低于对照组(P<0.05)。干预后观察组机械通气时间、入住ICU时间短于对照组(P<0.05),干预后观察组APACHEⅡ评分、脏器功能损伤评分(SOFA)较对照组显著下降(P<0.05)。结论:FRC导向的机械通气策略能有效改善重症肺炎患者呼吸力学及血流动力学相关指标,降低患者机械通气相关并发症,改善患者预后。Objective:To explore the application of functional residual capacity(FRC)-oriented mechanical ventilation strategy in the treatment of severe pneumonia.Methods:A total of 94 cases of mechanically ventilated patients with se⁃vere pneumonia and admitted to the ICU from July 2018 to December 2019 were collected.They were divided into obser⁃vation group(n=47)and control group(n=47)with randomly.The patients were adopted with empirical mechanical venti⁃lation treatment strategy before intervention.The control group was titrated with static P-V curve method.The observation group was adjusted with the mechanical ventilation strategy guided by FRC.The respiratory oxygenation mechanics,he⁃modynamic indexes,complications and prognosis of two groups were compared before and after intervention.Results:The respiratory mechanics related indexes(FRC,PEEP、Cst、PIP、Pplat、Pm),respiratory oxygenation index(PaO_(2),OI,SaO_(2),SvO_(2),Lac),hemodynamic indexes(CI、SVRI、PVPI、EVLWI)of observation group were improved more than those of the control group after intervention(P<0.05).The tract bleeding,pneumothorax,and tracheal intubation blockage or shedding of observation group were lower than those of the control group(P<0.05).The mechanical ventilation time and ICU stay of observation group after intervention were shorter than those of the control group(P<0.05).The APACHEⅡscore and organ function damage score(SOFA)of observation group were significantly lower than those of the control group after intervention(P<0.05).Conclusion:FRC-guided mechanical ventilation strategy can effectively improve the respiratory mechanics and hemodynamic related indexes of patients with severe pneumonia,reduce the complications related to mechanical ventilation,and improve the prognosis of patients.

关 键 词：功能残气量 机械通气 重症肺炎 并发症 

分 类 号：R563.1[医药卫生—呼吸系统]