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

    DU Wei-ya, HE Jian-hang,HUI Ping, et al

    (Wuyi TCM Hospital of Jiangmen, Guangdong Jiangmen 529031，China)

    Abstract: Objective: To study the therapeutic effects of pressure controlled ventilation post –traumatic acute respiratory distress syndrome (ARDS). Method: Eighteen patients with post–traumatic ARDS were included in the study. The patients received mechanical ventilation immediately after admission and were randomly 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 (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. ......