机械通气治疗急性呼吸窘迫综合征的肺复张策略研究

目的:探讨机械通气治疗急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)的肺复张策略的作用。方法:选择2012年1月~2012年12月我院收治的采用机械通气并进行肺复张治疗的ARDS患者94例,根据肺复张方法不同,将所有患者分为对照组和实验组,并比较两组患者的不同时点的氧合指数、肺顺应性及两组出现的并发症。结果:对照组肺复张成功率为72.34%,实验组肺复张成功率为95.75%,X2=38.928,P0.05,两组患者肺复张成功率差异具有统计学意义。两组患者氧合指数、肺顺应性和PaCO2在肺复张实施前比较,差异无统计学意义。肺复张策略实施后24h、48h和72h的氧合指数和PaCO2比较,这三个时点的氧合指数和PaCO2差异具有统计学意义。两组患者肺顺应性在肺复张策略实施后1h、2h和6h比较,t分别=4.939,5.391和5.999,P0.05,此三个时点的肺顺应性差异同样具有统计学意义。对照组气压伤发生率为82.98%,实验组气压伤发生率为59.57%,两组患者气压伤发生率差异具有统计学意义。结论:ARDS的患者在机械通气治疗的过程中上采用肺复张策略,不但可以提高肺复张成功率,改善肺部通气效果,且安全性好,适合临床使用。

Research of the Strategy of Recruitment Maneuver by Mechanical Ventilation to Cure acute Respiratory Distress Syndrome

Objective： To analyze the effects of the strategy of recruitment maneuver by mechanical ventilation to cure acute respiratory distress syndrome. Methods： 94 patients with acute respiratory distress syndrome during Nov.2012 -Dec. 2012 in our hospital were enrolled in this study. The patients were divided into experiment group and control group according to the ways of treatment To compare the levels of TOI, lung compliance, PaCO2 and complications of two groups. Results： The success rate of the control group was 72.34%, and of the experiment group was 95.75%,X^2=-38.928,P 〈0.05,the success rate of two groups were statistically significant. There were no significant difference of TOI , lung compliance and PaCO2 for before treatment. Differences of TOI and PaCO2 of treatment after 24h, 48h and 72h between two groups were significant as well as lung compliance of treatment after lh, 2h and 6h （t =4.939, 5.391and 5.999, P〈0.05）. The incidence rate of barotrauma for control group was 82.98% ,the incidence rate of barotrauma for control group was 59.57%, they were statistically significant. Conclusion： The strategy of recruitment maneuver for mechanical ventilation to cure acute respiratory distress syndrome can improve the success rate and ventilation for lung, fine safety, it is suitable for further application in clinical work.