以限制跨肺驱动压为导向的ARDS肺保护性通气的临床研究(1)
【摘要】 目的：研究以限制跨肺驱动压为导向的急性呼吸窘迫综合征(ARDS)肺保护性通气的临床效果。方法：选取笔者所在医院2016年5月-2018年3月住院明确诊断中重度ARDS患者60例。按照随机数字表法将其分为对照组(传统低潮气量滴定设置PEEP治疗)和治疗组(以限制跨肺驱动压为导向的机械通气治疗)，各30例。比较两组治疗前后的氧合指标(OI、PaO2、SaO2、FiO2)、呼吸力学指标(肺顺应性、跨肺驱动压)以及28 d死亡率、机械通气时间、住院时间。结果：治疗后，治疗组OI、PaO2、SaO2均高于对照组，FiO2均低于对照组，比较差异均有统计学意义(P<0.05)；治疗后，治疗组肺顺应性高于对照组，跨肺驱动压低于对照组，比较差异均有统计学意义(P<0.05)；治疗组机械通气时间、住院时间均短于对照组，28 d死亡率低于对照组，比较差异均有统计学意义(P<0.05)。结论：以限制跨肺驱动压为导向的ARDS肺保护性通气的临床效果较传统低潮气量滴定设置PEEP更优越。
【关键词】 限制跨肺驱动压； ARDS； 肺保护性通气
【Abstract】 Objective：To study the clinical effect of acute respiratory distress syndrome(ARDS) pulmonary protective ventilation guided by limit cross pulmonary driving pressure.Method：A total of 60 patients with moderate or severe ARDS diagnosed in hospital from May 2016 to March 2018 were selected.According to the random number table method，they were divided into control group(traditional low tidal volume titration with PEEP treatment) and treatment group(guided by mechanical ventilation with limited trans lung drive pressure)，30 cases in each group.The oxygenation indexes(OI，PaO2，SaO2，FiO2)，respiratory mechanics indicators(lung compliance end cross pulmonary driving pressure) before and after treatment，and 28 d mortality，mechanical ventilation time and hospitalization time between two groups were compared.Result：After treatment，the OI，SaO2 and PaO2 in treatment group were higher than those of control group，while FiO2 were lower than those of control group(P<0.05).After treatment，the lung compliance in treatment group were higher than those of control group，the cross pulmonary driving pressure were lower than those of control group，the differences were statistically significant(P<0.05).The mechanical ventilation time and hospitalization time of treatment group were shorter than those of control group，and 28 d mortality was lower than that of control group，the differences were statistically significant(P<0.05).Conclusion：The clinical effect of ARDS pulmonary protective ventilation guided by limit cross pulmonary driving pressure is better than that of traditional low tidal volume titration setting PEEP.
【Key words】 Limit cross pulmonary pressure； ARDS； Pulmonary protective ventilation
First-author’s address：Sichuan Mianyang No.404 Hospital，Mianyang 621000，China
doi：10.3969/j.issn.1674-4985.2018.24.001
急性呼吸窘迫综合征(Acute respiratory distress syndrome，ARDS)是重症医学科领域死亡率很高综合征，重度ARDS死亡率高达60%[1]。机械通气是治疗ARDS的主要手段，但应用不当可增加死亡率[2]。目前传统小潮气量通气治疗ARDS已成为主流治疗方法[3]，传统肺保护通气策略，即小潮气量(6 mL/kg)低平台压(≤30～35 cm H2O)辅以合适呼气末正压通气(PEEP)的保護性肺通气策略能降低ARDS患者肺损伤的发生率，并改善生存率[4-5]。但近年来的另一些研究结果也让人们开始对现有的保护性肺通气策略产生质疑，单纯限制潮气量和平台压并不能完全保证安全[6]，这与ARDS的肺组织异质性及“婴儿肺”相关。为探讨更安全的ARDS机械通气方法，减少机械通气过程中的肺损伤，明显改善氧合状况，改善肺功能，降低ARDS死亡率，远期提高生活质量，本研究比较了传统低潮气量加滴定PEEP组与以限制跨肺驱动压为导向的ARDS肺保护性通气的临床效果。现报道如下。, http://www.100md.com(叶碧华 杨天星 黄明礼 廖群芬 钱竣 李秀丹)
【关键词】 限制跨肺驱动压； ARDS； 肺保护性通气
【Abstract】 Objective：To study the clinical effect of acute respiratory distress syndrome(ARDS) pulmonary protective ventilation guided by limit cross pulmonary driving pressure.Method：A total of 60 patients with moderate or severe ARDS diagnosed in hospital from May 2016 to March 2018 were selected.According to the random number table method，they were divided into control group(traditional low tidal volume titration with PEEP treatment) and treatment group(guided by mechanical ventilation with limited trans lung drive pressure)，30 cases in each group.The oxygenation indexes(OI，PaO2，SaO2，FiO2)，respiratory mechanics indicators(lung compliance end cross pulmonary driving pressure) before and after treatment，and 28 d mortality，mechanical ventilation time and hospitalization time between two groups were compared.Result：After treatment，the OI，SaO2 and PaO2 in treatment group were higher than those of control group，while FiO2 were lower than those of control group(P<0.05).After treatment，the lung compliance in treatment group were higher than those of control group，the cross pulmonary driving pressure were lower than those of control group，the differences were statistically significant(P<0.05).The mechanical ventilation time and hospitalization time of treatment group were shorter than those of control group，and 28 d mortality was lower than that of control group，the differences were statistically significant(P<0.05).Conclusion：The clinical effect of ARDS pulmonary protective ventilation guided by limit cross pulmonary driving pressure is better than that of traditional low tidal volume titration setting PEEP.
【Key words】 Limit cross pulmonary pressure； ARDS； Pulmonary protective ventilation
First-author’s address：Sichuan Mianyang No.404 Hospital，Mianyang 621000，China
doi：10.3969/j.issn.1674-4985.2018.24.001
急性呼吸窘迫综合征(Acute respiratory distress syndrome，ARDS)是重症医学科领域死亡率很高综合征，重度ARDS死亡率高达60%[1]。机械通气是治疗ARDS的主要手段，但应用不当可增加死亡率[2]。目前传统小潮气量通气治疗ARDS已成为主流治疗方法[3]，传统肺保护通气策略，即小潮气量(6 mL/kg)低平台压(≤30～35 cm H2O)辅以合适呼气末正压通气(PEEP)的保護性肺通气策略能降低ARDS患者肺损伤的发生率，并改善生存率[4-5]。但近年来的另一些研究结果也让人们开始对现有的保护性肺通气策略产生质疑，单纯限制潮气量和平台压并不能完全保证安全[6]，这与ARDS的肺组织异质性及“婴儿肺”相关。为探讨更安全的ARDS机械通气方法，减少机械通气过程中的肺损伤，明显改善氧合状况，改善肺功能，降低ARDS死亡率，远期提高生活质量，本研究比较了传统低潮气量加滴定PEEP组与以限制跨肺驱动压为导向的ARDS肺保护性通气的临床效果。现报道如下。, http://www.100md.com(叶碧华 杨天星 黄明礼 廖群芬 钱竣 李秀丹)