不同机械通气模式治疗老年重症胸部损伤合并急性呼吸窘迫综合征的效果评价
Evaluation of the clinical effect of different mechanical ventilation modes in the treatment of severe thoracic injury complicated with acute respiratory distress syndrome in elderly patients
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摘要: 目的：探讨3种不同机械通气模式治疗重症胸部损伤合并急性呼吸窘迫综合征（ARDS）病人的临床效果。方法：重症胸部损伤合并ARDS老年病人90例均给予呼吸机机械通气治疗，并且根据病人自身情况选择3种不同的通气模式。30例采用同步间歇性指令通气（SIMV）+呼气末正压通气（PEEP）（SIMV+PEEP组），30例采用连续性气道通气（CPAP）+压力支持（PSV）模式（CPAP+PSV组），余30例采用压力控制通气（PCV）模式（PCV组）。对比3组临床疗效、呼吸模式参数和治疗前后的血气分析指标。结果：3组临床疗效差异无统计学意义（P>0.05），SIMV+PEEP组和CPAP+PSV组治疗后各病死1例，PSV组无死亡病例。CPAP+PSV组分钟通气量（MV）、动脉血氧分压（PaO2）、氧饱和度（SaO2）水平均高于SIMV+PEEP组和PCV组（P<0.05~P<0.01），吸气末峰压（PIP）、动脉血二氧化碳分压（PaCO2）水平均低于SIMV+PEEP组和PCV组（P<0.05~P<0.01）。3组PaO2、PaCO2、SaO2及氧合指数（PaO2/FiO2）均较治疗前明显改善（P<0.01）；CPAP+PSV组病人PaO2/FiO2均高于SIMV+PEEP组及PCV组（P<0.01和P<0.05）。结论：3种机械通气模式均能改善老年重症胸部损伤合ARDS病人的低氧血症，CPAP+PSV模式在降低PIP方面比其他2种通气模式有优势，更适于连枷胸的治疗。Abstract: Objective: To investigate the clinical effects of three kinds of mechanical ventilation modes in the treatment of severe thoracic injury complicated with acute respiratory distress syndrome(ARDS).Methods: Ninety elderly patients with severe thoracic injury complicated with ARDS were treated with mechanical ventilation by breathing machine,and three different ventilation modes were implemented according to the patient's situation.Thirty patients were treated with synchronous intermittent mandatory ventilation(SIMV) combined with positive end expiratory pressure(PEEP) (SIMV+PEEP group),30 patients were treated with continuous airway ventilation(CPAP) combined with pressure support(PSV)(CPAP+PSV group),and 30 cases were treated with pressure controlled ventilation(PCV)(PCV group).The clinical effects,respiratory mode parameters and blood gas analysis before and after treatment between three groups were compared.Results: The differences of the clinical effects between three groups were not statistically significant(P>0.05),one case in SIMV+PEEP group and one case in CPAP+PSV group and no case in PCV group died.The levels of Minvol(MV),alveolar oxygen partial pressure(PaO2) and arterial oxygen saturation(SaO2) in CPAP+PSV group were higher than those in SIMV+PEEP group and PCV group(P<0.05 to P<0.01),while the levels of proximal interphalangeal(PIP) and partial pressure of carbon dioxide in artery(PaCO2) in CPAP+PSV group were lower than those in SIMV+PEEP group and PCV group(P<0.05 to P<0.01).Compared with before treatment,the PaO2,PaCO2,SaO2 and PaO2/FiO2(fraction of inspiration O2) in 3 groups were significantly improved after treatment(P<0.01).The PaO2/FiO2 in CPAP+PSV group was higher than that in SIMV+PEEP group and PCV group(P<0.01 and P<0.05).Conclusions: All three kinds of mechanical ventilation modes can improve the hypoxia in elderly patients with severe thoracic injury complicated with ARDS.The CPAP+PSV mode has advantage over the another two ventilation modes in reducing the peak inspiratory pressure,which is more suitable for the treatment of flail chest.
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