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目的通过回顾性分析探究高频振荡通气与常规机械通气对烟雾吸入性肺损伤致急性呼吸窘迫综合征(ARDS)患者的临床疗效,为选择正确的通气模式提供参考。方法收集我院危重病监护中心2004年10月至2015年6月期间烧伤合并烟雾吸入性肺损伤致ARDS患者43例,其中24例接受高频振荡通气治疗(HFOV组),19例接受常规通气治疗(CV组),对比分析两组患者于入院后规定时间点(第6 h、24 h、48 h、96 h、7 d)的血气变化、并发症和预后情况。结果通气治疗前两组患者动脉血氧分压(PaO_2)、动脉二氧化碳分压(PaCO_2)、动脉血氧分压/吸氧浓度比值(PaO_2/FiO_2)差异无统计学意义(P>0.05),通气治疗后除第48 h、96h PaCO_2未见明显差异外(P>0.05),其余规定时点HFOV组各血气指标较CV组改善更明显(P<0.05)。HFOV组患者住院与通气时间较CV组明显缩短(P<0.05)。两组患者死亡率与严重并发症发生率差异均无统计学意义(P>0.05),30天累计生存率提示两组患者生存曲线无显著差异(P>0.05)。结论高频振荡通气与常规通气模式均能改善烟雾吸入性肺损伤致ARDS患者的临床状况,当前研究并不能说明两种通气模式下患者预后具有差异。
Objective To investigate the clinical effects of high-frequency oscillatory ventilation and conventional mechanical ventilation on patients with acute respiratory distress syndrome (ARDS) induced by smoke-induced pulmonary injury through retrospective analysis and provide a reference for choosing the correct ventilation mode. Methods Forty-three ARDS patients with burn injury and inhalational lung injury were collected from October 2004 to June 2015 in our critical care center. Among them, 24 were treated with high-frequency oscillatory ventilation (HFOV) and 19 were routinely ventilated (CV group). The blood gas changes, complications and prognosis of the two groups were compared at prescribed time points (6h, 24h, 48h, 96h, 7d) after admission. Results There was no significant difference in PaO_2, PaCO_2, PaO_2 / FiO_2 between the two groups before ventilation (P> 0.05) Ventilation after treatment in addition to 48h, 96h PaCO_2 no significant difference (P> 0.05), the rest of the time point HFOV group than the blood gas index improved more significantly (P <0.05). The duration of hospitalization and ventilation in HFOV group was significantly shorter than that in CV group (P <0.05). There was no significant difference between the two groups in the incidence of mortality and serious complications (P> 0.05). The 30-day cumulative survival rate showed no significant difference between the two groups (P> 0.05). Conclusions Both high-frequency oscillatory ventilation and conventional ventilation can improve the clinical status of patients with ARDS induced by smoke inhalation injury. The current study does not show the difference in prognosis between the two ventilation modes.