无创与有创机械通气治疗急性肺损伤比较研究

摘要

目的：比较无创与有创机械通气方式救治急性肺损伤的临床疗效。方法：将32例急性肺损伤患者随机分为两组，无创通气组常规治疗基础上加用无创正压通气( NIPPV)，有创通气组常规治疗基础上加用气管插管接呼吸机同步间歇指令通气( SIMV)+呼气末正压( PEEP)模式通气。观察各组治疗1小时后心率、呼吸频率、动脉血气分析、氧合指数等指标的变化并比较不同通气方法的差异性。结果：经无创或有创通气治疗后，两组组内患者的心率(HR)、呼吸频率(RR)、血气分析指标及氧合指数改善明显，差异有显著性(P<0.05)。治疗后两组组间血气分析指标及氧合指数比较亦存在显著差异，即有创组治疗后较无创组治疗后在PaO2及氧合指数明显高于后者(P<0.05)。无创组和有创组的有效率分别为66.7%和94.1%，差异有显著性(P<0.05)。结论：在治疗急性肺损伤方面，有创机械通气和无创机械通气都能改善患者低氧血症，但有创机械通气效果更好。%Objective To investigate the application of different mechanical ventilation mode in the saving of acute lung injury ( ALI) combined with hypoxemia. Method 32 patients with ALI combined with hypoxemia were divided into two groups randomly. In addition to conventional therapy, the first group was applied NIPPV and the second group was applied SIMV+ PEEP. Evaluating the changes of heart rate( HR), respiratory rate(RR), PaO2 and PaO2/ FiO2 after 1 hours between two groups. Result After 1 hour, the PaO2 and PaO2/FiO2 ratio were significantly increased more in the two groups than before(P<0. 05). The PaO2/FiO2 ratio was significantly higher in the groupII than that in the groupⅠ(P<0. 05), and the improvement rate was also significantly higher in the groupIIthan that in the groupⅠ(94. 1%:66. 7%,P<0. 05) . Conclusion Non-invasive ventilation and invasive ventilation both have effect on ALI,but invasive ventilation have better effect on improving oxygenation than non-invasive ventilation.