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目的探讨肺保护性通气策略在结核性毁损肺机械通气治疗中的应用价值及其对患者预后的影响。方法选取86例行机械通气治疗的结核性毁损肺患者为研究对象,用随机数字表法分为研究组(n=43)和对照组(n=43)。研究组予以肺保护性通气策略下机械通气疗法[潮气量为6-8m L/kg,呼气末正压通气(PEEP)为5-9cm H_2O],对照组予以常规机械通气疗法(潮气量为10-12m L/kg,PEEP为0-4cm H_2O)。观察对比两组受试者通气前后血气指标变化情况,并比较二者平均通气时间、肺气压伤发生率、呼吸机相关性肺炎发生率、死亡率差异。结果通气后,两组患者PaCO_2水平均较通气前显著降低,两组患者PH值水平、氧合指数与PaO_2水平则较通气前显著提升,差异均有统计学意义(P<0.05);且组间比较差异亦有统计学意义(P<0.05)。研究组平均通气时间显著短于对照组,差异有统计学意义(P<0.05)。两组通气后死亡率比较,差异无统计学意义(P>0.05);研究组肺气压伤发生率显著低于对照组,差异有统计学意义(P<0.05);研究组呼吸机相关性肺炎发生率显著低于对照组,差异有统计学意义(P<0.05)。结论本研究发现肺保护性通气策略在改善肺结核毁损肺患者机械通气治疗效果,降低肺气压伤及呼吸机相关性肺炎发生率,缩短上机时间等方面优于常规通气策略,值得临床应用和推广。
Objective To investigate the value of lung protective ventilation strategy in the treatment of tuberculous detoxification lung mechanical ventilation and its effect on the prognosis of patients. Methods Totally 86 patients with tuberculous and destroying lungs undergoing mechanical ventilation were enrolled in this study. The patients were randomly divided into study group (n = 43) and control group (n = 43). The study group was given mechanical ventilation therapy [tidal volume of 6-8m L / kg, PEEP of 5-9cm H_2O] under the protective ventilation strategy, and the control group was given conventional mechanical ventilation (the tidal volume was 10-12 m L / kg, PEEP 0-4 cm H 2 O). The changes of blood gas indexes before and after ventilation were observed and compared between the two groups. The mean duration of ventilation, the incidence of pneumoconiosis, the incidence of ventilator-associated pneumonia and mortality were compared. Results After ventilation, the PaCO 2 levels in both groups were significantly lower than those before ventilation. The PH values, oxygenation index and PaO 2 levels in both groups were significantly higher than those before ventilation (P 0. 05) The difference between the two groups was also statistically significant (P <0.05). The study group average ventilation time was significantly shorter than the control group, the difference was statistically significant (P <0.05). There was no significant difference in mortality rate between the two groups after ventilation (P> 0.05). The incidence of pneumoconiosis in the study group was significantly lower than that in the control group (P <0.05). The ventilator-associated pneumonia The incidence was significantly lower than the control group, the difference was statistically significant (P <0.05). Conclusion This study found that the protective ventilation strategy is superior to conventional ventilation strategy in improving mechanical ventilation in patients with pulmonary tuberculosis and lung damage, reducing the incidence of pulmonary pressure injury and ventilator-associated pneumonia, and shortening the on-board time, which is worthy of clinical application and promotion .