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目的评价肺保护性通气及CVVH干预在控制急性肺损伤(ALI)和防治多器官功能障碍综合征(MODS)及降低其病死率中的作用。方法60例ALI患者随机分为肺保护性通气组(A组)和肺保护性通气及CVVH干预组(B组)各30例,比较两组患者呼吸力学、动脉血气及血流动力学的变化,观察两组患者肺及肺外器官功能改善率、机械通气并发症发生率、ICU病死率及其死亡原因等。结果两组患者的年龄和APACHE 11评分比较差异无统计学意义(P>0.05);A组及B组对ALI患者的呼吸力学、动脉血气及血流动力学的影响均优于A组;肺保护性通气及B组对肺及肺外器官功能改善率明显优于A组,另外,机械通气所致肺损伤的发生率、机械通气相关心肌缺血和心律失常的发生率也均明显下降;B组因多器官功能衰竭(MOF)的ICU病死率为13.33%,明显优于A组(46.64%,P<0.05)。结论肺保护性通气及CVVH干预能改善ALI患者的呼吸力学、动脉血气及血流动力学,能降低其呼吸机所致肺损伤(VILI)、机械通气相关心肌缺血和心律失常的发生率,在防治MODS及降低ALI患者病死率上有显著的临床效果。
Objective To evaluate the role of pulmonary protective ventilation and CVVH intervention in the control of acute lung injury (ALI) and in the prevention and treatment of multiple organ dysfunction syndrome (MODS) and its mortality. Methods Sixty patients with ALI were randomly divided into three groups: protective ventilation group (group A), protective ventilation group (group B) and ventilation protective group (group B). The changes of respiration, arterial blood gas and hemodynamics were compared between the two groups , To observe the lung and extrapulmonary organ function improvement rate, the incidence of mechanical ventilation complications, ICU mortality and the causes of death in both groups. Results There was no significant difference in age and APACHE 11 score between the two groups (P> 0.05). A group and B group had better effects on respiration, arterial blood gas and hemodynamics than those of A group. Protective ventilation and group B improved lung and extrapulmonary function better than group A. In addition, the incidence of lung injury induced by mechanical ventilation and the incidence of mechanical ventilation-induced myocardial ischemia and arrhythmia also decreased significantly. In group B, the ICU mortality rate of multiple organ failure (MOF) was 13.33%, which was significantly better than that of group A (46.64%, P <0.05). Conclusion Pulmonary protective ventilation and CVVH intervention can improve the respiratory mechanics, arterial blood gas and hemodynamics of ALI patients, reduce the ventilator-induced lung injury (VILI), the incidence of mechanical ventilation-induced myocardial ischemia and arrhythmia, In the prevention and treatment of MODS and reduce the mortality of ALI patients have a significant clinical effect.