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目的对比分析肺保护性通气与传统机械通气措施在严重胸部创伤并发急性呼吸窘迫综合征(ARDS)患者的急诊施救中的临床价值。方法选择2011年2月—2013年6月来宁波镇海龙赛医院就诊的胸部严重创伤并发ARDS患者共42例,男性28例,女性14例,平均年龄35.5岁;均给予急诊对症治疗,依据机械辅助通气方式的不同,分为肺保护性通气组(n=30)和传统机械通气组(n=12),比较2组患者的动脉血气分析值、呼吸机相关肺损伤发生率及病死率的差异性。结果肺保护性通气组患者比传统机械通气组的动脉血氧分压显著增高[(82.45±13.56)vs.(65.72±14.46)mm Hg,t=4.267,P=0.016],二氧化碳分压显著降低[(34.10±12.29)vs.(48.21±11.26)mm Hg,t=-3.064,P=0.023],动脉血氧分压与吸入气氧浓度比值显著增高[(341.76±32.48)vs.(252.12±30.89),t=6.924,P<0.001],呼吸机相关肺损伤发生率及病死率显著降低(10.0%vs.41.7%,P<0.001;13.3%vs.50.0%,P<0.001),差异均有统计学意义。结论严重胸部创伤患者并发ARDS采取肺保护性通气措施可在一定程度上改善血气分析、肺损伤发生率及减少病死率,改善临床预后。
Objective To compare and analyze the clinical value of pulmonary protective ventilation and traditional mechanical ventilation in the emergency rescue of patients with severe chest trauma complicated with acute respiratory distress syndrome (ARDS). Methods A total of 42 patients with severe chest trauma complicated with ARDS who were treated at Ningbo Hailong Sai Hospital from February 2011 to June 2013 were selected, 28 males and 14 females, with an average age of 35.5 years. All patients were given emergency symptomatic treatment. (N = 30) and traditional mechanical ventilation group (n = 12). The arterial blood gas analysis value, ventilator-related lung injury and mortality were compared between the two groups difference. Results Compared with the conventional mechanical ventilation group, the partial pressure of arterial oxygen in patients with lung-protective ventilation group was significantly higher than that in the conventional mechanical ventilation group (82.45 ± 13.56 vs. 65.72 ± 14.46 mm Hg, t = 4.267, P = 0.016) (34.10 ± 12.29 vs. 48.21 ± 11.26 mm Hg, t = -3.064, P = 0.023). The ratio of arterial oxygen to inhaled oxygen was significantly higher (341.76 ± 32.48 vs. 252.12 ± 30.89), t = 6.924, P <0.001]. The incidence of ventilator-associated lung injury and mortality were significantly lower (10.0% vs.41.7%, P <0.001; 13.3% vs.50.0%, P <0.001) There is statistical significance. Conclusion Severe thoracic trauma patients complicated with ARDS pulmonary protective ventilation measures to some extent, to improve blood gas analysis, the incidence of lung injury and reduce mortality and improve clinical prognosis.