摘要
目的总结和探讨严重胸腹伤并发急性呼吸窘迫综合征(ARDS)的机械通气治疗方法。方法回顾分析90例严重胸腹伤并发ARDS的诊治经过。根据机械通气策略和方法的不同将本组病例分成两组:传统机械通气组38例,肺保护性通气组52例。比较两组通气时间、氧合状况、呼吸机相关肺损伤(VALI)发生率及病死率。结果传统机械通气组通气时间平均(7.56±2.49)天,氧合指数为276.58±24.20,VALI发生率44.74%,病死率34.21%;肺保护性通气组通气时间平均(5.47±2.81)天,氧合指数为362.38±27.66,VALI发生率19.23%,病死率13.46%。与传统机械通气相比,肺保护性通气治疗能缩短通气时间,改善氧合状况,降低VALI发生率及病死率。结论对严重胸腹伤并发ARDS患者,肺保护性通气的治疗效果明显优于传统机械通气,值得在临床上推广应用。
Objective To summarize and discuss the therapeutic strategies of mechanical ventilation for severe thoracic and abdomenal trauma complicated by acute respiratory distress syndrome（ ARDS）. Methods Ninety cases of severe thoracic and abdomenal trauma complicated by ARDS were reviewed. Thirty-eight cases received traditional mechanical ventilation therapy, and 52 cases received pulmonary protective ventilation. The ventilator-carried time, oxygenation,the incidence of ventilator-associated lung injury （VALI） and fatality rate were compared between two strategies of mechanical ventilation. Results In patients treated with traditional mechanical ventilation, average ventilator-carried time was （ 7.56 ± 2.49 ） days, oxygen index was （ 276.58 ± 24.20 ）, the incidence of VALI was 44.74%, and fatality rate was 34.21%. In patients treated with pulmonary protective ventilation, average ventilator-carried time was（5.47 ± 2.81 ） days, oxygen index was （362.38 ± 27.66）, the incidence of VALI was 19.23% ,and fatality rate was 13.46%. Compared with traditional mechanical ventilation ,the therapeutic strategies of pulmonary protective ventilation shorten ventilator-carried time, improved oxygenation, reduced the incidence of VALI and the fatality rate. Conclusion Pulmonary protective ventilation in treating severe thorax and abdomen trauma complicated by ARDS is more effective than traditional mechanical ventilation,and should be applied clinically.
出处
《创伤外科杂志》
2007年第5期388-390,共3页
Journal of Traumatic Surgery
