摘要
目的观察低牵张通气策略治疗急性呼吸窘迫综合征（ARDS）的临床疗效。方法将85例ARDS患者随机分为低牵张通气组（42例）和小潮气量通气组（43例）。低牵张通气组接受峰压≤35cmH2O（1cm H2O=0．098kPa）的压力限制或压力支持模式以满足气道平台压≤30cmH2O；小潮气量通气组接受潮气量≤6ml／kg的容量辅助控制通气模式。分析比较两组患者28d病死率、高碳酸血症发生率、镇静和肌松药物使用时间、存活患者呼吸机带机时间及住重症监护病房（ICU）时间；低牵张通气组患者根据监测呼出潮气量（Vte）分为小潮气量通气亚组（V，e≤6ml／kg，11例）和非小潮气量通气亚组（Vre〉6ml／kg，31例），分析两个亚组间患者的28d病死率及高碳酸啦症发生率。结果低牵张通气组患者28d病死率与小潮气量通气组无显著差异（34．O％比37．O％，P〉0．05），但低牵张通气组高碳酸血症发生率明显低于小潮气量通气组（10．6％比40．7％，P〈0．05），镇静和肌松药物使用时间（（4．5±1．2）d比（8．7±2．3）d3、存活患者带机时间[（8．4±2．1）d比（10．7±1．2）d3及住IcU时间[（10．2±2．2）d比（13．7±3．1）d3均相应缩短（尸均〈0．05）；低牵张通气组中小潮气量通气比例为26．2％，小潮气量通气亚组病死率（40．8％比13．2％）和高碳酸血症发生率（65．7％比8．6％）均显著高于非小潮气量通气亚组（P均〈O．05）。结论与小潮气量通气策略比较，低牵张通气策略可降低高碳酸血症的发生率，缩短患者带机时间及住ICU时间。低牵张通气状态下，小潮气量可能与不良预后相关。
Objective To investigate the effectiveness of low-stretch as compared with low tidal volume strategy in the treatment of acute respiratory distress syndrome （ARDS）. Methods Eighty-five cases of ARDS patients were randomly divided into low-stretch group （42 cases） and low tidal volume group （43 cases）. Theformergroup of patient received pressure assist control mode with not higher than 35 cm H2O （1 cm H2O = 0. 098 kPa） of peak pressure or pressure support mode ventilation with not higher than 30 cm H2O of Pplateau, while in low tidal volume group tidal volume of no more than 6 rnl/kg of predicted boby weight was given. The mortality rate within 28 days, the incidence of hypercapnia, the duration of using sedatives and neuromuscular blockade agents, the time of ventilation and the length of intensive care unit （ICU） stay were compared between two groups. According to the monitored expiratory tidal volume （Vte）, the low-stretch group was divided into low tidal volume subgroup （VTe≤ 6 ml/kg, 11 cases） and non-low tidal volume subgroup （VTe〉6 ml/kg, 31 cases）. The mortality within 28 days and the incidence of hypereapnia were compared between two subgroups. Results There was no significant difference in the 28-day mortality rate between two groups （34.0% vs. 37.0%, P〉0.05）, but patients of low-stretch group had lower incidence of hypercapnia than low tidal volume group （10.6% vs. 40.7%, P〈0. 05）, and also the duration of using sedatives （（4.5± 1.2） days vs. （8.7 ± 2.3） days9 and neuromuscular blockade agents （（8.4±2.1） days vs. （10.7±1.2） days3, and the length of ventilation andICU stay [（10.2±2.2） days vs. （13.7±3.1） days, all P〈0. 053 were less. Low tidal volume occurred in 26.2% of low-stretch group, and the low tidal volume subgroup had higher 28-day mortality rate （40.8%） and incidence of hypercapnia （65.7%） than non-low tidal volume subgroup （13.2% and 8.6%, both P〈0. 05）. Conclusion Compared with low tidal volume s
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2009年第10期609-612,共4页
Chinese Critical Care Medicine
关键词
急性呼吸窘迫综合征
低牵张
小潮气量
机械通气
治疗
acute respiratory distress syndrom
low-stretch
low tidal volume
mechanical ventilation
treatment
