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目的观察肺复张手法联合双水平正压通气对急性呼吸窘迫综合征(ARDS)患者的治疗作用,并与小潮气量辅助/控制通气方式进行比较,以寻找更合理的机械通气方式。方法 28例ARDS 患者,男15例,女13例,平均年龄(37±9)岁。符合中华医学会呼吸病学分会制定的 ARDS 诊断标准。分为两组:(1)试验组14例:采用肺复张手法联合双水平正压机械通气;(2)对照组14例:采用美国 ARDS 协会推荐的小潮气量辅助/控制通气(潮气量设为6 ml/kg,体重为标准体重)。分别观察两组患者上机后0、48和72 h 的氧合指数、肺顺应性(ml/cm H_2O)、中心静脉压、镇静药物的用量以及28 d 的病死率和并发症等。结果试验组与对照组比较,氧合指数48 h 分别为(298±16)及(212±12)cm H_2O(1 cm H_2O=0.098 kPa),72 h 为(309±16)及(246±17)cm H_2O;肺顺应性48 h分别为(38.4±2.2)及(29.5±1.3)ml/cm H_2O,72 h 为(42.0±1.3)及(29.0±1.0)ml/cm H_2O;带机时间缩短为(14±3)及(19±3)d;试验组和对照组48 h 中心静脉压分别为(13.8±0.8)及(18.6±1.1)cm H_2O,72 h 分别为(11.6±0.7)及(16.8±1.0)cm H_2O。试验组仅在上机时应用少量镇静剂,而对照组则连续应用至通气方式转为自主通气方式。28 d 病死率和并发症的发生率两组比较差异无统计学意义(U=0.38,P>0.05)。结论肺复张手法联合双水平正压通气方式比单纯小潮气量容量控制/辅助通气具有改善氧合迅速、肺顺应性增加明显、带机时间短、血液动力学稳定及所用镇静药物少等优点。
Objective To observe the therapeutic effect of pulmonary augmentation combined with bilevel positive pressure ventilation on patients with acute respiratory distress syndrome (ARDS) and to compare with the mode of small tidal volume assisted ventilation / control ventilation in order to find a more reasonable way of mechanical ventilation. Methods 28 ARDS patients, 15 males and 13 females, mean age (37 ± 9) years. In line with the Chinese Medical Association respiratory disease developed ARDS diagnostic criteria. Divided into two groups: (1) the experimental group of 14 patients: the use of pulmonary tonic combined with bi-level positive pressure mechanical ventilation; (2) the control group of 14 patients: the United States ARDS Association recommended small tidal volume assisted / controlled ventilation 6 ml / kg, body weight is standard body weight). Oxygenation index, pulmonary compliance (ml / cm H 2 O), central venous pressure, sedation drug dosage and mortality and complication of 28 days were observed at 0, 48 and 72 h after operation. Results Compared with the control group, the oxygenation index of the experimental group was (298 ± 16) and (212 ± 12) cm H 2 O (1 cm H 2 O = 0.098 kPa) for 48 h and was (309 ± 16) and ) cm H_2O. The lung compliance was (38.4 ± 2.2) and (29.5 ± 1.3) ml / cm H 2 O at 48 h and (42.0 ± 1.3) and (29.0 ± 1.0) ml / cm H 2 O at 72 h (13 ± 0.8) and (18.6 ± 1.1) cm H_2O for 48 h in experimental group and control group respectively, and (11.6 ± 0.7) and (11.6 ± 0.7) (16.8 ± 1.0) cm H 2 O. The test group only applied a small amount of sedation on the machine, while the control group was continuously applied to ventilation to autonomic ventilation. There was no significant difference in mortality and complication between the two groups at 28 days (U = 0.38, P> 0.05). Conclusions Pulmonary recanalization combined with bi-level positive airway pressure ventilation has the advantages of rapid oxygenation, significant increase of pulmonary compliance, shortened machine time, stable hemodynamics and less sedative drugs than simple tidal volume control / assisted ventilation.