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目的：探讨急性呼吸窘迫综合征（ＡＲＤＳ）运用气道压力限制和容许性高碳酸血症机械通气的效果。方法：将２９２ 例ＡＲＤＳ患者随机分为３ 组，Ａ 组９６ 例，未用机械通气；Ｂ组１０２ 例，用传统策略机械通气〔潮气量（１２．１５±１．８６）ｍ ｌ／ｋｇ，呼气末正压（１．４０±０．４５）ｋＰａ（１ ｋＰａ＝ １０．２０ ｃｍ Ｈ２Ｏ），平台压（３．４０±０．４３）ｋＰａ，动脉血二氧化碳分压（５．４８±１．１０）ｋＰａ（１ ｋＰａ＝ ７．５ ｍ ｍ Ｈｇ），ｐＨ 值７．３６±０．０４〕；Ｃ组９４ 例，运用气道压力限制和容许性高碳酸血症策略机械通气〔潮气量（７．５８±０．４２）ｍ ｌ／ｋｇ，呼气末正压（０．７８±０．２３）ｋＰａ，平台压（２．８０±０．４１）ｋＰａ，动脉血二氧化碳分压（１０．１５±１．３８）ｋＰａ，ｐＨ值７．２１±０．０３〕。对Ａ、Ｂ、Ｃ３组患者疗效进行比较。结果：Ａ组与Ｂ、Ｃ组相比，未实施机械通气患者的病死率显著升高（Ｐ均＜ ０．０１）；Ｂ组与Ｃ组相比，Ｂ组患者病死率又高于Ｃ组（Ｐ＜ ０．０５）。结论：机械通气可以显著减少呼吸衰竭致ＡＲＤＳ的病死率；气道压力限制和容许性高碳酸血症策略机械通气可进一步降低ＡＲＤＳ病死率。
Objective: To investigate the effect of airway pressure limitation and permissive hypercapnic mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). Methods: A total of 292 patients with ARDS were randomly divided into 3 groups: group A (n = 96) without mechanical ventilation; group B (n = 102) with mechanical ventilation (tidal volume of 12.15 ± 1.86 m l / kg, Positive end expiratory pressure (1.40 ± 0.45) kPa (1 kPa = 10.20 cm H2O), plateau pressure (3.40 ± 0.43) kPa, arterial partial pressure of carbon dioxide .10) kPa (1 kPa = 7.5 m m Hg), pH 7.36 ± 0.04); Group C, 94 patients were treated with airway pressure limitation and permissive hypercapnia strategy. Mechanical ventilation [Tidal volume (7.58 ± 0.42) m l / kg, positive end expiratory pressure (0.78 ± 0.23) kPa, plateau pressure (2.80 ± 0.41) kPa, arterial partial pressure of carbon dioxide .15 ± 1.38) kPa, pH 7.21 ± 0.03〕. The efficacy of A, B, C3 patients were compared. Results: The mortality of patients without mechanical ventilation in group A was significantly higher than those in groups B and C (all P <0.01). The mortality in group B was significantly higher than that in group C (P <0.05). CONCLUSIONS: Mechanical ventilation can significantly reduce the mortality of ARDS caused by respiratory failure; airway pressure limitation and permissive hypercapnia strategy of mechanical ventilation can further reduce ARDS mortality.