Objective To evaluate the effects of airway pressure release ventilation ( APRV) and synchronized in-termittent mandatory ventilation ( SIMV ) on the clinical efficacy in patients with acute respiratory distress syndrome (ARDS).Methods Twenty-four ARDS patients were randomized to receive SIMV (n=12) or APRV (n=12).Both groups underwent a combined therapy including rational use of antibiotics , appropriate sedation , supports of organ func-tion and homeostasis maintenance under a lung protective ventilation strategy .All patients were monitored for arterial PaO2 and PaCO2, oxygen index (PaO2/FiO2), dynamic compliance of the lungs (Cdyn) and extravascular lung water in-dex (ELWI).Meanwhile, the levels of TNF-αand IL-6 in plasma were measured using enzyme -linked immunosor-bent assay (ELLSA).Also, the doses of fentanyl and midazolam for 24 hours, total fluid balance and vasoactive drug do-ses were recorded .Results Compared with the SIMV group , those receiving APRV presented significantly improved val-ues of PaO2/FiO2 and Cdyn 24 hours after mechanical ventilation (P<0.05 or P<0.01), reduced levels of TNF -α, IL-6 and ELWI (P<0.01 ), as well as obvious decreases in the doses of fentanyl , midazolam, and vasoactive drugs and positive fluid balance volume (P<0.01).Conclusion After APRV, patients are in an improved oxygenation status with reduced values of Cdyn and ELWI as well as weakened inflammation and positive fluid balance volume who also re -quire less doses of sedatives .%目的：评价气道压力释放通气（APRV）和同步间歇指令通气（SIMV）2种不同的机械通气模式对于急性呼吸窘迫综合征（ ARDS ）患者临床疗效的影响。方法将24例接受有创机械通气的ARDS患者随机分为SIMV组和APRV组，2组均采用肺保护性通气策略，予合理使用抗生素，适当镇静、镇痛，脏器功能支持，维持内环境稳定等综合治疗。监测动脉血气、动态肺顺应性（Cdyn）及肺血管外肺水指数（ELWI）指标，检测血浆肿瘤坏死因子（TNF）α、白细胞介素（IL）6水平，并记录24 h芬太尼和咪达唑仑用量、液体平衡量及血管活性药物用量。结果与SIMV组相比，APRV组通气24 h后氧合指数（PaO2／FiO2）及Cdyn改善（P＜0．05或P＜0．01），TNF －α、IL－6、ELWI降低（P＜0．01），24 h芬太尼、咪达唑仑用量及液体正平衡量明显减少（P＜0．01）。结论 APRV能改善患者的氧合状态及Cdyn，减轻炎症反应，降低ELWI，减少镇静剂用量及液体正平衡量。
展开▼
