小潮气量通气在具有发生急性呼吸窘迫综合征高危因素患者中的应用研究

摘要

目的：探讨小潮气量通气用于具有急性呼吸窘迫综合征（ARDS）高危因素患者机械通气后的临床疗效。方法选择2014年8月至2016年9月入住本院将重症医学科和传染科监护室的200例急性呼吸衰竭需有创机械通气患者作为研究对象，按单随机化法按进行机械通气先后分成研究组和对照组，各100例。研究组给予小潮气量6～8 mL ／kg ，呼吸末正压5～8 mm H2 O ，对照组气管插管后给予潮气量10～12 mL ／kg 、根据病情呼吸末正压0～5 mm H2 O 。比较通气后患者的氧分压、二氧化碳分压、氧合指数、呼吸力学指标、炎症指标、机械通气指标、住院时间、ARDS 发生率、28 d 病死率。结果研究组患者 PaO2和PaO2／FiO2改善效果较对照组更明显（P ＜0．05）。而在 pH 值和 PaCO2指标方面，两组患者治疗后差异无统计学意义（P＞0．05）；肺顺应性增强明显，气道峰压和平台压明显低于对照组，差异有统计学意义（P＜0．05）；治疗后，研究组患者的 IL‐6水平相比较于对照组显著的降低，差异有统计学意义（P＜0．05），研究组患者的 TNF‐α水平也显著低于对照组，差异有统计学意义（P＜0．05）；研究组患者的住院时间、ARDS 发生率和28 d 病死率均显著低于对照组患者，差异具有统计学意义（P＜0．05）。结论小潮气量通气用于具有 ARDS 高危因素患者机械通气后，具有减少肺损伤，降低 ARDS 发生率，降低病死率效果，值得临床广泛应用。%Objective To explore the clinical effect of low tidal volume ventilation used in the patients with high risk factors of acute respiratory distress syndrome (ARDS) .Methods Two hundreds patients with acute respiratory failure requiring invasive me‐chanical ventilation admitted to ICU of the intensive medicine and infection departments of our hospital from August 2014 to Sep‐tember 2016 were selected as research subjects ,by a single randomized method for conducting the mechanical ventilation they were divided into the study group and the control group ,100 cases in each group .The study group received low tidal volume 6 - 8 mL/kg ,end expiratory pressure 5 - 8 mm H2 O ,while the control group was given tidal volume 10 - 12 mL/kg after tracheal intubation , and the positive expiratory end pressure 0 - 5 mm H2 O according to the disease condition .The oxygen partial pressure(PaO2 ) ,par‐tial pressure of carbon dioxide(PaCO2 ) ,oxygenation index ,respiratory mechanical indicators ,inflammatory indicators ,mechanical ventilation indicators ,hospitalization time ,ARDS occurrence rate ,28 d mortality rate after ventilation were compared .Results The PaO2 and PaO2 / FiO2 improvement effect in the study group was more obvious than those in the control group (P< 0 .05) .The pH value and PaCO2 indicators after treatment had no statistically significant differences between the two groups(P> 0 .05) ;the lung compliance enhance was obvious ,the peak airway pressure and plateau pressure were significantly lower than those in the control group ,the difference was statistically significant (P< 0 .05) ;the IL6 level after treatment in the study group was significantly de‐creased compared with the control group ,the difference was statistically significant (P< 0 .05) ,the TNF‐α level in the study group was also significantly lower than that in the control group ,the difference was statistically significant (P< 0 .05) ;the hospitalization time ,incidence rate of ARDS and 28 d mortality rate in the study group were significantly lower than those in the control group ,the difference was statistically significant (P< 0 .05) .Conclusion The application of low tidal volume ventilation in the patients with high risk factors of ARDS has the efficacies for reducing the pulmonary injury ,decreasing the ARDS occurrence rate and mortality rate ,which is worthy of being widely applied in clinic .