持续高水平PEEP治疗肺内源性ARDS的临床价值研究

目的：探索持续高水平呼气末正压通气（PEEP）治疗肺内源性急性呼吸窘迫综合征（ARDS）的临床价值,为机械通气治疗ARDS提供依据.方法：收集70例肺内源性ARDS患者的临床资料,根据其PEEP是否＞12 cmH2O,分为观察组和对照组,比较两组患者的机械通气后PaO2和PaCO2的改善情况、气压伤发生率、住ICU时间、机械通气时间以及病死率.结果：两组患者机械通气0h、24 h、72 h后PaO2和PaCO2的改善情况无差异（P＞0.05）,1周后观察组PaO2为（159.41±29.16）、PaCO2为（44.51士10.23）,对照组PaO2为（286.14±38.46）、PaCO2为（40.21±8.97）,两组对比差异显著（P＜0.05）;观察组住ICU时间、平均机械通气时间和病死率为（11.78±9.86）d、（7.56±6.09）d、34.51％,对照组为（6.51±8.97）d、（3.98±5.76）d、18.76％,两组对比差异有统计学意义（P＜0.05）;观察组有3例气压伤,对照组无气压伤发生.结论：持续高水平PEEP治疗肺内源性ARDS患者并不能有效改善氧合,但延长患者住ICU时间,增加病死率.

Clinical value of continuous high-level positive end-expiratory pressure in treating pulmonary endogenous acute respiratory distress syndrome

Objective： To explore the clinical value of continuous high-level positive end-expiratory pressure （PEEP） in treating pulmonary endogenous acute respiratory distress syndrome （ARDS） in order to provide basis for mechanical ventilation treatment of ARDS. Methods： Clinical data of 70 cases of pulmonary endogenous ARDS treated in my hospital were analyzed. Patients were divided into the observation group and the control group based on whether their PEEP〉12 cmH2O. The improvement of PaO2 and PaCO2, barotrauma incidence, duration in ICU, duration of mechanical ventilation and mortality rate of patients in both groups were compared. Results： 0 h, 24 h and 72 h after mechanical ventilation, there were no difference in the improvement of PaO2 and PaCO2 （P〉0.05） ; but after 1 week＇s mechanical ventilation, PaO2 and PaCO2 in the observation group and the control group were （159.41± 29. 16）, （44.51±10.23） and （286. 14±38.46）, （40. 21 ±8.97） respectively, which were of significant differences （P〈0; 05）. The duration in ICU, duration of mechanical ventilation and mortality rate of patients in the observation group were（11. 78± 9.86） ,（7.56±6.09）,34.51% respectively, while （6.51±8.97）, （3.98±5.76）, 18.76% respectively in the control group. There were significant differences between both groups （P〈 0.05）. There were 3 barotrauma in the observation group, but no barotrauma occurred in the control group. Conclusion. Continuous high-level PEEP in treating pulmonary endogenous ARDS patients can not improve the oxygenation of the patients effectively, and it may prolong the patients＇ duration in ICU and increase the mortality rate of the patients.