摘要:目的:探讨压力控制通气(PCV)用于治疗创伤性急性呼吸窘迫综合征(ARDS)的临床应用价值。方法:观察创伤性ARDS患者PCV组和容量控制通气(VCV)治疗后6和12h气道峰压(PIP),平均气道压(M Paw)和呼气末正压(PEEP)的大小,并比较PCV治疗对血气、血压和心率的影响。结果: PCV组治疗后6和12h PIP均显著低于VCV组(P均<0.01),6h M Paw和PEEP与VCV比较无显著差异(P均>0.05),而12h PCV组M Paw和PEEP均显著低于VCV组(P<0.05和P<0.01)。PCV组治疗后血气分析、心率和呼吸显著改善,血压无明显变化。结论:PCV治疗创伤性ARDS能显著降低PIP,并不增加M Paw和PEEP值,对血流动力学也无明显影响。
关键词: 创伤性湿肺；压力控制通气;容量控制通气
Clinical Research on Treatment of Severe Traumatic Wet Lung Using Pressure Controlled Ventilation
Abstract: Objective: To study the therapeutic effects of pressure controlled ventilation post traumatic acute respiratory distress syndrome (ARDS). Method: Eighteen patients with posttraumatic ARDS were included in the study. The patients received mechanical ventilation immediately after admission and wererandomly divided into two groups: pressure controlled ventilation (PCV) group (n=10) and volume controlled ventilation(VCV) group (n=10). Peak airway pressure (PIP), mean airway pressure (M Paw) and positive end-expiratory pressure (PEEP) at 6 hour (PTh6) and 12 hour (PTh12) after treatment in the two groups were recorded and compared. Blood gas analysis, blood pressure, heart and respiratory rates were compared before and after PCV treatment. Results: PIP in PCV group at PTh6 and PTh12 were (2.24±0.12) k Pa (1kPa=10.20cmH2O) and (1.98±0.08) k Pa, respectively, and were significantly lower than those in the VCV group (both P<0.01). The M Paw and PEEP in PCV group at PTh6 were (1.12±0.09) k Pa and 无忧论文 【http://www.uklunwen.com】(0.79±0.12) k Pa, respectively, and showed no significant difference with those in the VCV group (both P>0.05). But the two parameters at PTh12 in PCV group, which were (0.85±0.08) kPa and (0.55±0.04) k Pa respectively, were significantly lower than those in the VCV group(P<0.05 and P<0.01). The blood gas analysis, heart and respiratory rates were obviously improved in PCV treatment group, and no significant changes in blood pressure was observed. Conclusion: PCV can significantly lower the PIP level with no disturbance to M Paw, PEEP and hemo dynamics. It is useful in the treatment of post-traumatic ARDS.
Key words: Traumatic wet lung;Pressure control ventilation; Volume control ventilation
机械通气尤其是呼气末正压(ＰＥＥＰ)通气是治疗创伤性急性呼吸窘迫综合征(ＡＲＤＳ)最有效的手段。但是, 由于急性肺损伤时肺顺应性下降,故常规机械通气易引起气压伤、心输出量减少等副作用。为了提高机械通气对创伤性湿肺的疗效, 我们于2003年1月至2004年12月治疗重症创伤性湿肺20例, 分别采用压力控制通气(ＰＣＶ)和容量控制通气(ＶＣＶ)治疗各10例。现报告如下。
1 资料与方法
1.1 病例: 20例重症创伤性湿肺患者,男12例,女8例;年龄18～56岁, 平均35岁。诊断均符合文献［1］标准。原发胸外伤11例,胸腹联合伤9例。均使用Bennett7200AE型呼吸机,美国太空实验室多功能监测仪和血气分析仪。
1.2 治疗方法: 对确诊为重度创伤性湿肺患者快速建立人工气道, 其中经口气管插管16例 , 经鼻气管插管4例, 经口后改气管切开插管4例。气道开放时间1～120h,平均29.06h。20例患者建立人工气道采用单双日随机分为PCV组11例,男7例,女4例;年龄18～52岁,平均(40.4±14.7)岁。VCV组9例,男5例, 女4例;年龄22～53岁,平均(37.8±12.6)岁。二组均控制潮气量在6～7ml/kg, 氧浓度(FiO2)0.40～0.60, 呼吸频率(RR)12～25次/min。均常规加呼气末正压(PEEP) 通气在0.49～1.47kPa(1kPa=10.20 cmH2O), 吸∶呼比为1∶1～2。
1.3 观察方法:均进行床边定时监测动脉血气和电解质, 严密动态记录机械通气前后每小时的呼吸频率(RR)、心率(HR)、平均血压(MBP)和 |
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论文题目：
压力控制通气治疗重症创伤性湿肺的临床研究 
