CAJ | 학술논문

目的观察低牵张通气策略治疗急性呼吸窘迫综合征(ARDS)的临床疗效.方法将85例ARDS患者随机分为低牵张通气组(42例)和小潮气量通气组(43例).低牵张通气组接受峰压≤35 cm H2O(1 cm H2O=0.098 kPa)的压力限制或压力支持模式以满足气道平台压≤30 cm H2O;小潮气量通气组接受潮气量≤6 ml/kg的容量辅助控制通气模式.分析比较两组患者28 d病死率、高碳酸血症发生率、镇静和肌松药物使用时间、存活患者呼吸机带机时间及住重症监护病房(ICU)时间;低牵张通气组患者根据监测呼出潮气量(Vte)分为小潮气量通气亚组(Vte≤6 ml/kg,11例)和非小潮气量通气亚组(Vte>6 ml/kg,31例),分析两个亚组间患者的28 d病死率及高碳酸血症发生率.结果低牵张通气组患者28 d病死率与小潮气量通气组无显著差异(34.0%比37.0%,P>0.05),但低牵张通气组高碳酸血症发生率明显低于小潮气量通气组(10.6%比40.7%,P<0.05),镇静和肌松药物使用时间[(4.5±1.2)d比(8.7±2.3)d]、存活患者带机时间[(8.4±2.1)d比(10.7±1.2)d3及住ICU时间[(10.2±2.2)d比(13.7±3.1)d3均相应缩短(P均<0.05);低牵张通气组中小潮气量通气比例为26.2%,小潮气量通气亚组病死率(40.8%比13.2%)和高碳酸血症发生率(65.7%比8.6%)均显著高于非小潮气量通气亚组(P均<0.05).结论与小潮气量通气策略比较,低牵张通气策略可降低高碳酸血症的发生率,缩短患者带机时间及住ICU时间.低牵张通气状态下,小潮气量可能与不良预后相关.
목적 관찰저견장통기책략치료급성호흡군박종합정(ARDS)적림상료효.방법 장85례ARDS환자수궤분위저견장통기조(42례)화소조기량통기조(43례).저견장통기조접수봉압≤35 cm H2O(1 cm H2O=0.098 kPa)적압력한제혹압력지지모식이만족기도평태압≤30 cm H2O;소조기량통기조접수조기량≤6 ml/kg적용량보조공제통기모식.분석비교량조환자28 d병사솔、고탄산혈증발생솔、진정화기송약물사용시간、존활환자호흡궤대궤시간급주중증감호병방(ICU)시간;저견장통기조환자근거감측호출조기량(Vte)분위소조기량통기아조(Vte≤6 ml/kg,11례)화비소조기량통기아조(Vte>6 ml/kg,31례),분석량개아조간환자적28 d병사솔급고탄산혈증발생솔.결과 저견장통기조환자28 d병사솔여소조기량통기조무현저차이(34.0%비37.0%,P>0.05),단저견장통기조고탄산혈증발생솔명현저우소조기량통기조(10.6%비40.7%,P<0.05),진정화기송약물사용시간[(4.5±1.2)d비(8.7±2.3)d]、존활환자대궤시간[(8.4±2.1)d비(10.7±1.2)d3급주ICU시간[(10.2±2.2)d비(13.7±3.1)d3균상응축단(P균<0.05);저견장통기조중소조기량통기비례위26.2%,소조기량통기아조병사솔(40.8%비13.2%)화고탄산혈증발생솔(65.7%비8.6%)균현저고우비소조기량통기아조(P균<0.05).결론 여소조기량통기책략비교,저견장통기책략가강저고탄산혈증적발생솔,축단환자대궤시간급주ICU시간.저견장통기상태하,소조기량가능여불량예후상관.
Objective To investigate the effectiveness of low-stretch as compared with low tidal volume strategy in the treatment of acute respiratory distress syndrome CARDS).Methods Eighty-five cases of ARDS patients were randomly divided into low-stretch group(42 cases)and low tidal volume group (43 cases).The former group of patient received pressure assist control mode with not higher than 35 cm H2O (1 cm H2O=0.098 kPa)of peak pressure or pressure support mode ventilation with not higher than 30 cm H2O of Pplateau,while in low tidal volume group tidal volume of no more than 6 ml/kg of predicted boby weight was given.The mortality rate within 28 days,the incidence of hypercapnia,the duration of using sedatives and neuromuscular blockade agents,the time of ventilation and the length of intensive care unit(ICU)stay were compared between two groups.According to the monitored expiratory tidal volume (VTe),the low-stretch group was divided into low tidal volume subgroup(VT≤6 ml/kg,11 cases)and non-low tidal volume subgroup(VTe>6 ml/kg,31 cases).The mortality within 28 days and the incidence of hypercapnia were compared between two subgroups.Results There was no significant difference in the 28-day mortality rate between two groups(34.0% vs.37.0%,P>0.05),but patients of low-stretch group had lower incidence of hypercapnia than low tidal volume group(10.6% vs.40.7%,P<0.05).and also the duration of using sedatives[(4.5±l.2)days vs.(8.7 ±2.3)days]and neuromuscular blockade agents [(8.4±2.1)days vs.(10.7±1.2)days],and the length of ventilation and ICU stay[(10.2±2.2)days vs.(13.7±3.1)days,all P<0.05]were less.Low tidal volume occurred in 26.2% of low-stretch group,and the low tidal volume subgroup had higher 28-day mortality rate(40.8%)and incidence of hypercapnia(65.7%)than non-low tidal volume subgroup(13.2% and 8.6%,both P<0.05).Conclusion Compared with low tidal volume strategy,low-stretch strategy can reduce the incidence of hypercapnia,the length of ventilation and ICU stay for ARDS patients,but have similar mortality rate.When low-stretech strategy is exercised,an inappropriate low tidal volume may be associated with poor outcome of ARDS.