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目的:分析甲型H1N1流感危重症患者在机械通气时发生气压伤的危险因素。方法:对2009年11月-2010年2月山东省胸科医院ICU收治的15例行机械通气的甲型H1N1流感危重症患者按有无发生气压伤分成两组,对患者性别、年龄、28 d在院病死率、急性生理学和慢性健康状况评分、肺损伤评分、氧合指数及呼吸支持时肺部静态顺应性、呼吸频率、呼气末正压、最大吸气压力、潮气量和氧浓度指标进行回顾分析。结果:气压伤组患者的肺损伤评分、吸入氧浓度明显高于无气压伤组患者(P=0.001,P=0.008),肺部静态顺应性(Cstat)要明显低于未出现气压伤的患者(P=0.024),两组之间差异具有统计学意义。两组患者的年龄、性别、APACHEⅡ评分、呼气末正压、最大吸气压力、潮气量和呼吸频率之间差异无统计学意义(P均>0.05)。结论:甲型H1N1流感病毒对肺组织的严重损害及其导致的肺静态顺应性下降可能是导致危重症患者机械通气时发生气压伤的重要因素。
Objective: To analyze the risk factors of barotrauma during mechanical ventilation in critically ill patients with influenza A (H1N1). Methods: Fifteen critically ill patients with mechanically ventilated A (H1N1) influenza admitted to the ICU of Shandong Chest Hospital from November 2009 to February 2010 were divided into two groups according to their presence or absence of barotrauma, and their gender, age, 28 d hospital lung mortality, acute physiology and chronic health score, lung injury score, oxygenation index and respiratory support at static lung compliance, respiratory rate, positive end expiratory pressure, maximum inspiratory pressure, tidal volume and oxygen concentration Indicators for a retrospective analysis. Results: The scores of lung injury and inhaled oxygen in patients with barotrauma group were significantly higher than those in patients without barotrauma group (P = 0.001, P = 0.008). The lung static compliance (Cstat) was significantly lower than those without barotrauma (P = 0.024), the difference between the two groups was statistically significant. There was no significant difference in age, sex, APACHEⅡscore, positive end expiratory pressure, maximum inspiratory pressure, tidal volume and respiratory rate between the two groups (all P> 0.05). Conclusion: The severe damage to lung tissue and the consequent decrease of static compliance of lung caused by influenza A (H1N1) virus may be the important factors that lead to barotrauma during mechanical ventilation in critically ill patients.