大型呼吸机无创通气治疗胸部外伤所致急性肺损伤临床观察

Noninvasive ventilatory support in the management of acute lung injury after thoracic trauma by complex critical ventilator

关键词:  无创通气  胸部外伤  急性肺损伤

Key words:  noninvasive ventilatory support  acute lung injury  thoracic trauma

摘要:

［目的］评价采用大型多功能呼吸机无创通气治疗胸部外伤所致急性肺损伤（acute lung injury，ALI）的临床效果。［方法］对47例胸部外伤导致ALI患者进行前瞻性病例对照研究,随机分为无创通气组（21例）和有创机械通气组（26例），观察无创通气组（ 通气前、通气1 h、通气12 h和撤机后）动脉血氧分压、氧合指数、呼吸频率及辅助呼吸肌动用评分，以及两组间病死率、呼吸机并发症发生率、机械通气治疗时间、住院时间的差异。［结果］无创通气组不同时间（通气1 h、通气12 h和撤机后）动脉血氧分压、氧合指数较无创通气前均有明显改善（P<0.05），呼吸频率及辅助呼吸肌动用评分在通气后12 h及撤机后较无创通气前下降（P<0.05）；有、无创通气治疗组间比较，无创通气治疗组机械通气并发症发生率、机械通气治疗时间及住院时间少于有创通气治疗组（P<0.05），但在病死率方面两组间差异并无显著性意义（P>0.05）。［结论］大型呼吸机无创通气是治疗胸部外伤所致急性肺损伤的有效方法，有创机械通气治疗仍是胸部外伤所致ALI，特别是恶化至急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）患者的重要治疗手段。

Abstract:

［Objective］To evaluate the effect of noninvasive ventilatory support (NIV) in the management of acute lung injury (ALI) after thoracic trauma by complex critical ventilator.［Methods］A prospective study involved 47 patients suffered ALI after thoracic trauma. All the patients were randomized into 2 groups, 21 patients in NIV, and 26 patients in invasive mechanical ventilation (IMV). PaO₂, ratio of partial of arterial oxygen to the fraction of inspired oxygen (PaO₂/FiO₂), respiratory rate (RR) and score of the accessory respiratory muscle use were measured at pre-ventilation, 1 hour and 12 hours post-ventilation and after weaning, respectively. Meanwhile the mortality, ventilation time, complications of ventilation and hospitalization duration were recorded. ［Results］ PaO₂, PaO₂/FiO₂, RR and score of the accessory respiratory muscle use of the patients with ALI were improved significantly after complex critical ventilator (P<0.05). The complications of ventilation, ventilation time and hospitalization duration of NIV were less and shorter than those with IMV. But the mortality between the two groups had no significant difference (P>0.05). ［Conclusion］ Using NIV through complex critical ventilator early is an effective way to treat ALI after thoracic trauma. Meantime IMV is still important for patients with ALI even ARDS after thoracic trauma.