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目的探讨重症急性胰腺炎(AP)并发急性呼吸窘迫综合征(ARDS)的肺保护通气策略的临床效果。方法AP并发ARDS行气管插管机械通气患者56例,保持平台压<35cmH2O,最高不超过40cmH2O,肺容积低于压力容积曲线的高拐点。当平台压<25cmH2O时,预设潮气量6~8ml/kg;平台压在25~30cmH2O时,预设潮气量5~6ml/kg;如平台压>30cmH2O或有增高趋势,则用压力控制通气,保持pH值7.30~7.45。使用最佳呼气末正压(PEEP),吸入氧浓度(FIO2)尽量保持≤60%,氧和目标是PaO255~80mmHg或SaO288%~95%。结果机械通气时间7~31d,平均(16±6.4)d,控制性低通气时间3~7d,与通气前比较,通气后8h和48hPaO2/FIO2明显改善(P<0.01),PaCO2在通气后48h显著增加(P<0.05),pH值变化不明显(P>0.05)。无气压伤发生。结论以平台压为靶压力管理目标,适时选用容量通气或压力控制通气,合理调整参数,真正实行个体化保护性通气策略,最大程度地避免了呼吸机相关性肺损伤的发生。
Objective To investigate the clinical effects of lung protection ventilation in patients with severe acute pancreatitis (AP) complicated with acute respiratory distress syndrome (ARDS). Methods Fifty-six patients with mechanical ventilation with ARDS and endotracheal intubation were treated with AP with a platform pressure <35cmH2O and a maximum of 40cmH2O. The lung volume was below the high inflection point of the pressure-volume curve. When the platform pressure is less than 25cmH2O, the preset tidal volume is 6 ~ 8ml / kg; when the platform pressure is 25 ~ 30cmH2O, the preset tidal volume is 5-6ml / kg; if the platform pressure is> 30cmH2O or there is an increasing trend, , Keep the pH value 7.30 ~ 7.45. With optimal PEEP, the inspired oxygen concentration (FIO2) should be kept as low as 60% and the oxygen and target should be PaO255 ~ 80mmHg or SaO288% ~ 95%. Results The duration of mechanical ventilation was 7 ~ 31 days, with an average of (16 ± 6.4) days and controlled hypopnea time of 3 ~ 7 days. Compared with those before ventilation, the values of 8th and 48hPaO2 / Fio2 improved significantly after ventilation (P <0.01) (P <0.05), but the pH did not change significantly (P> 0.05). No pressure injury occurred. Conclusions Taking platform pressure as the target of pressure management, volume ventilation or pressure-controlled ventilation are selected timely to adjust the parameters reasonably, and the personalized protective ventilation strategy is practically implemented to avoid the ventilator-associated lung injury to the greatest extent.