摘要
目的评价大潮气量(VT)通气对围手术期呼吸机相关性肺炎(VAP)的治疗价值。方法选择心肺功能较好、一般情况稳定的手术后VAP患者26例,随机分为对照组和治疗组,观察5d。对照组维持原常规或小VT及其他通气参数不变,治疗组改用大VT、慢呼吸频率(RR)通气。结果 1h后,治疗组VT从(7.8±0.6)ml/kg增至(13.5±1.1)ml/kg(P<0.001),RR从(23±6)次/min降至(16±3)次/min(P<0.001),气道峰压(Ppeak)从(29.2±2.3)cmH2O降至(22.6±2.5)cmH2O(P<0.001),PaO2从(77.4±5.8)mmHg升至(110.6±11.7)mmHg(P<0.001),PaCO2和pH基本无变化(P>0.05);24h后体温从(38±0.5)℃下降至(37.6±0.4)℃(P<0.05);5d后T降至(36.6±0.7)℃(P<0.001),白细胞从(15.3±3.2)×109/mm3下降至(8.6±2.5)×109/mm3(P<0.001),肺部渗出性病变所占比例从44%±9%减少至18.8%±3.6%(P<0.001)。对照组除渗出性病变略减少外,其他指标皆无明显改善,两组结果比较差异皆有统计学意义(P<0.05)。结论大潮气量通气能较快改善围手术期VAP患者的低氧血症和肺部感染。
Objective To evaluate the effect of large tidal volume（VT） ventilation on ventilator-associated pneumonia（VAP）during perioperation.Methods Twenty-six VAP patients with good heart and lung function and stable general condition after operation were selected and randomly divided into control group and treatment group.The patients were observed for 5 days,during which the heart and lung function,small tidal volume and other ventilation parameters were not changed for the patients in control group,while large VT and slow respiratory rate（RR） ventilation were used for the patients in treatment group.Results In treatment group,the VT was increased from（7.8±0.6）ml/kg to（13.5±1.1）ml/kg,the RR was decreased from（23±6）times/min to（16±3）times/min,the peak airway pressure was decreased from（29.2±2.3）cmH2O to（22.6±2.5）cmH2O,the PaO2 was increased from（77.4±5.8）mmHg to（110.6±11.7）mmHg with no significant change of PaCO2 and pH after 1h,the body temperature was decreased from（38±0.5）℃ to（37.6±0.4）℃ after 24h and further decreased to（36.6±0.7）℃（P0.001） after 5 days,the number of white blood cells was decreased from（15.3±3.2）×109/mm3 to（8.6±2.5）×109/mm3,the infiltrated area of lung was decreased from 44%±9% to 18.8%±3.6% after 5 days（P0.001 or P0.05）.In control group,however,these parameters were not significantly changed except for the infiltrated area of lung（P0.05）.Conclusion Large VT mechanical ventilation can rapidly improve hypoxemia and pulmonary infection in VAP patients during perioperation.
出处
《军医进修学院学报》
CAS
2011年第3期222-224,共3页
Academic Journal of Pla Postgraduate Medical School
关键词
肺炎
呼吸机相关性
潮气量
低氧血症
Pneumonia
Ventilator Associated
Tidal Volume
Hypoxemia
