中国医药
中國醫藥
중국의약
China Medicine
2015年
10期
1439-1441
,共3页
玉素甫江·牙库甫%肖克来提·霍加合买提%帕尔哈提·拜合提
玉素甫江·牙庫甫%肖剋來提·霍加閤買提%帕爾哈提·拜閤提
옥소보강·아고보%초극래제·곽가합매제%파이합제·배합제
呼吸窘迫综合征,成人%潮气量%呼吸,人工
呼吸窘迫綜閤徵,成人%潮氣量%呼吸,人工
호흡군박종합정,성인%조기량%호흡,인공
Respiratory distress syndrome,adult%Tidal volume%Respiration,artificial
目的 探讨常规潮气量与小潮气量机械通气治疗外伤性急性呼吸窘迫综合征(ARDS)患者的临床效果.方法 回顾性分析新疆医科大学第一附属医院2012年3月至2014年1月收治的64例外伤性ARDS患者的治疗资料,根据机械通气潮气量分为常规组(28例)和非常规组(36例).常规组机械通气潮气量为10 ～ 12 ml/kg,非常规组机械通气潮气量为6～8 ml/kg.比较2组患者通气后即刻和通气后24、48、96 h氧合指数、动脉血二氧化碳分压(PaCO2)、pH值,通气后即刻、通气后96 h静脉血和肺泡灌洗液中肿瘤坏死因子α(TNF-oα)、白细胞介素6(IL-6)水平,以及多器官功能障碍综合征(MODS)、呼吸机所致肺损伤(VILI)发生率及病死率.结果 非常规组患者通气24、48、96 h后氧合指数和PaCO2均明显高于通气后即刻[(159±25)、(178±31)、(225 ±40)比(106±29);(45±5)、(48±5)、(50±5)mmHg(1 mmHg=0.133 kPa)比(39±5)mmHg],差异均有统计学意义(均P＜0.05).通气后96 h,非常规组和常规组静脉血和肺泡灌洗液中TNF-α、IL-6水平均明显低于通气后即刻[非常规组TNF-α:(11.8 ±2.1)ng/L比(31.5±3.3) ng/L,(10.3±1.8) ng/L比(25.1±3.0) ng/L,非常规组IL-6:(13.5±2.4) ng/L比(40.8±3.7) ng/L,(14.3±2.5) ng/L比(36.1 ±3.9)ng/L;常规组TNF-α:(20.4±3.4)ng/L比(30.7±3.2) ng/L,(17.5±2.8) ng/L比(24.8±3.1)ng/L,非常规组IL-6:(24.8±3.1) ng/L比(41.5±2.8) ng/L,(22.8±2.8) ng/L比(36.4±3.4)ng/L],且非常规组明显低于常规组,差异均有统计学意义(均P＜0.05).非常规组MODS发生率、VILI发生率、病死率均明显低于常规组[2.8％ (1/36)比17.9％ (5/28)、5.6％ (2/36)比28.6％ (8/28)、2.8％(1/36)比17.9％(5/28)],差异均有统计学意义(均P＜0.05).结论 小潮气量机械通气治疗外伤性ARDS能提高患者氧合指数,降低静脉血和肺泡灌洗液中TNF-α、IL-6水平,同时降低MODS、VILI发生率及病死率.
目的 探討常規潮氣量與小潮氣量機械通氣治療外傷性急性呼吸窘迫綜閤徵(ARDS)患者的臨床效果.方法 迴顧性分析新疆醫科大學第一附屬醫院2012年3月至2014年1月收治的64例外傷性ARDS患者的治療資料,根據機械通氣潮氣量分為常規組(28例)和非常規組(36例).常規組機械通氣潮氣量為10 ～ 12 ml/kg,非常規組機械通氣潮氣量為6～8 ml/kg.比較2組患者通氣後即刻和通氣後24、48、96 h氧閤指數、動脈血二氧化碳分壓(PaCO2)、pH值,通氣後即刻、通氣後96 h靜脈血和肺泡灌洗液中腫瘤壞死因子α(TNF-oα)、白細胞介素6(IL-6)水平,以及多器官功能障礙綜閤徵(MODS)、呼吸機所緻肺損傷(VILI)髮生率及病死率.結果 非常規組患者通氣24、48、96 h後氧閤指數和PaCO2均明顯高于通氣後即刻[(159±25)、(178±31)、(225 ±40)比(106±29);(45±5)、(48±5)、(50±5)mmHg(1 mmHg=0.133 kPa)比(39±5)mmHg],差異均有統計學意義(均P＜0.05).通氣後96 h,非常規組和常規組靜脈血和肺泡灌洗液中TNF-α、IL-6水平均明顯低于通氣後即刻[非常規組TNF-α:(11.8 ±2.1)ng/L比(31.5±3.3) ng/L,(10.3±1.8) ng/L比(25.1±3.0) ng/L,非常規組IL-6:(13.5±2.4) ng/L比(40.8±3.7) ng/L,(14.3±2.5) ng/L比(36.1 ±3.9)ng/L;常規組TNF-α:(20.4±3.4)ng/L比(30.7±3.2) ng/L,(17.5±2.8) ng/L比(24.8±3.1)ng/L,非常規組IL-6:(24.8±3.1) ng/L比(41.5±2.8) ng/L,(22.8±2.8) ng/L比(36.4±3.4)ng/L],且非常規組明顯低于常規組,差異均有統計學意義(均P＜0.05).非常規組MODS髮生率、VILI髮生率、病死率均明顯低于常規組[2.8％ (1/36)比17.9％ (5/28)、5.6％ (2/36)比28.6％ (8/28)、2.8％(1/36)比17.9％(5/28)],差異均有統計學意義(均P＜0.05).結論 小潮氣量機械通氣治療外傷性ARDS能提高患者氧閤指數,降低靜脈血和肺泡灌洗液中TNF-α、IL-6水平,同時降低MODS、VILI髮生率及病死率.
목적 탐토상규조기량여소조기량궤계통기치료외상성급성호흡군박종합정(ARDS)환자적림상효과.방법 회고성분석신강의과대학제일부속의원2012년3월지2014년1월수치적64예외상성ARDS환자적치료자료,근거궤계통기조기량분위상규조(28례)화비상규조(36례).상규조궤계통기조기량위10 ～ 12 ml/kg,비상규조궤계통기조기량위6～8 ml/kg.비교2조환자통기후즉각화통기후24、48、96 h양합지수、동맥혈이양화탄분압(PaCO2)、pH치,통기후즉각、통기후96 h정맥혈화폐포관세액중종류배사인자α(TNF-oα)、백세포개소6(IL-6)수평,이급다기관공능장애종합정(MODS)、호흡궤소치폐손상(VILI)발생솔급병사솔.결과 비상규조환자통기24、48、96 h후양합지수화PaCO2균명현고우통기후즉각[(159±25)、(178±31)、(225 ±40)비(106±29);(45±5)、(48±5)、(50±5)mmHg(1 mmHg=0.133 kPa)비(39±5)mmHg],차이균유통계학의의(균P＜0.05).통기후96 h,비상규조화상규조정맥혈화폐포관세액중TNF-α、IL-6수평균명현저우통기후즉각[비상규조TNF-α:(11.8 ±2.1)ng/L비(31.5±3.3) ng/L,(10.3±1.8) ng/L비(25.1±3.0) ng/L,비상규조IL-6:(13.5±2.4) ng/L비(40.8±3.7) ng/L,(14.3±2.5) ng/L비(36.1 ±3.9)ng/L;상규조TNF-α:(20.4±3.4)ng/L비(30.7±3.2) ng/L,(17.5±2.8) ng/L비(24.8±3.1)ng/L,비상규조IL-6:(24.8±3.1) ng/L비(41.5±2.8) ng/L,(22.8±2.8) ng/L비(36.4±3.4)ng/L],차비상규조명현저우상규조,차이균유통계학의의(균P＜0.05).비상규조MODS발생솔、VILI발생솔、병사솔균명현저우상규조[2.8％ (1/36)비17.9％ (5/28)、5.6％ (2/36)비28.6％ (8/28)、2.8％(1/36)비17.9％(5/28)],차이균유통계학의의(균P＜0.05).결론 소조기량궤계통기치료외상성ARDS능제고환자양합지수,강저정맥혈화폐포관세액중TNF-α、IL-6수평,동시강저MODS、VILI발생솔급병사솔.
Objective To explore the effect of conventional and low tidal volume ventilation on acute respiratory distress syndrome (ARDS) induced by trauma.Methods Totally 64 patients with ARDS undergoing mechanical ventilation from March 2012 to January 2014 were retrospectively analyzed.The patients were divided into conventional group (28 cases) with mechanical ventilation tidal volume of 10-12 ml/kg and unconventional group (36 cases) with mechanical ventilation tidal volume of 6-8 ml/kg.The arterial partial pressure of oxygen/ inspired oxygen concentration ratio (PaO2/FiO2),partial pressure of arterial carbon dioxide (PaCO2),pH value immediately,24,48 and 96 h after ventilation,the levels of tumor necrosis factor alpha (TNF-α) and interleukin (IL)-6 in arterial blood and bronchoalveolar lavage fluid levels immediately and 96 h after ventilation were compared between the two groups;the incidences of multiple organ dysfunction syndrome (MODS),ventilator induced lung injury (VILI) and mortality were compared between the two groups.Results Compared with those immediately after ventilation,the PaO2/FiO2 and PaCO2 were significantly increased 24,48,96 h after ventilation in unconventional group [(159±25),(178±31),(225±40) vs (106±29);(45±5),(48±5),(50±5) mmHg vs (39 ± 5) mmHg] (P ＜ 0.05).The levels of TNF-α,IL-6 in unconventional and conventional group 96 h after ventilation were obviously lower than immediately after ventilation in venous blood and bronchoalveolar lavage fluid [unconventional group TNF-α:(11.8 ± 2.1) ng/L vs (31.5 ± 3.3) ng/L,(10.3 ± 1.8) ng/L vs (25.1 ±3.0) ng/L,unconventional group IL-6:(13.5 ±2.4) ng/L vs (40.8 ±3.7) ng/L,(14.3 ±2.5)ng/L vs (36.1 ± 3.9) ng/L;conventional group TNF-α:(20.4 ± 3.4) ng/L vs (30.7 ± 3.2) ng/L,(17.5 ± 2.8) ng/L vs (24.8 ± 3.1) ng/L,conventional group IL-6:(24.8 ± 3.1) ng/L vs (41.5 ± 2.8) ng/L,(22.8 ± 2.8) ng/L vs (36.4 ± 3.4) ng/L],and unconventional group were significantly lower than conventional group (P ＜ 0.05).The incidences of MODS,VILI and mortality in unconventional group were significantly lower than those in conventional group [2.8％ (1/36) vs 17.9％ (5/28),5.6％ (2/36) vs 28.6％ (8/28),2.8％ (1/36) vs 17.9％ (5/28)] (P ＜ 0.05).Conclusion In treatment of traumatic ARDS,mechanical ventilation with small tidal volume can increase the PaO2/FiO2,,reduce the levels of TNF-α and IL-6 in venous blood and bronchoalveolar lavage fluid,and reduce the incidences of MODS,VILI and mortality.
