[1]王亿胜,李宏云#,冯永海,等.小潮气量通气对急性肺损伤/急性呼吸窘迫综合征高风险患者疗效及预后的影响[J].郑州大学学报(医学版),2014,(03):393.
 WANG Yisheng,LI Hongyun,FENG Yonghai,et al.Influence of low tital volume ventilation on curative effect and prognosis of patients with high risk ALI/ARDS[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2014,(03):393.
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小潮气量通气对急性肺损伤/急性呼吸窘迫综合征高风险患者疗效及预后的影响
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《郑州大学学报(医学版)》[ISSN:1671-6825/CN:41-1340/R]

卷:
期数:
2014年03期
页码:
393
栏目:
应用研究
出版日期:
2014-05-20

文章信息/Info

Title:
Influence of low tital volume ventilation on curative effect and prognosis of patients with high risk ALI/ARDS
作者:
王亿胜李宏云# 冯永海秦超刘培杰
郑州大学第五附属医院呼吸内科 郑州 450052
Author(s):
WANG YishengLI HongyunFENG YonghaiQIN ChaoLIU Peijie
Department of Respiratory Diseases,the Fifth Affiliated Hospital,Zhengzhou University,Zhengzhou 450052
关键词:
急性肺损伤/急性呼吸窘迫综合征高风险机械通气小潮气量炎症反应疗效
Keywords:
AbstractAim: To explore the influence of low tital volume ventilation on curative effect and prognosis of patients with high risk acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Methods: From August2012 to May2013 in the Fifth Affili
分类号:
R459.7
摘要:
摘要目的:探讨小潮气量通气对急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)高风险患者疗效及预后的影响。方法:选取2012年8月至2013年5月在郑州大学第五附属医院呼吸重症监护病房(RICU)住院的ALI/ARDS高风险患者68例为研究对象,将患者分成两组,小潮气量组(VT 6~8 mL/kg)36例,常规潮气量组(VT 10~12 mL/kg)32例。比较两组患者机械通气即刻、通气后48 h、96 h的血气分析结果,静脉血清、肺泡灌洗液中TNFα、IL6水平,以及机械通气治疗后ALI/ARDS发病率、机械通气时间、住RICU时间、住院时间、总死亡率。结果:①与机械通气即刻相比,两组患者静脉血清中TNFα、IL6水平逐渐下降,肺泡灌洗液中TNFα、IL6水平至通气96 h出现显著下降,小潮气量组炎性介质降幅较常规潮气量组更显著(P<0.05)。②与常规潮气量组相比,小潮气量组ALI/ARDS发病率、机械通气时间、住RICU时间、住院时间、总死亡率均有明显改善(P<0.05)。结论:机械通气可能会诱导ALI/ARDS高风险患者ALI/ARDS的发病,但对必须采取机械通气方式治疗的ALI/ARDS高风险患者,小潮气量通气较常规潮气量通气疗效更为显著、预后较好。
Abstract:
high risk of ALI/ARDS; mechanical ventilation; low tidal volume; inflammatory response; curative effect

参考文献/References:

[1]邵换璋.保护性机械通气治疗重症胸外伤并ARDS 10例[J].郑州大学学报:医学版,2004,39(4):733 [2]屈清荣,马继红.重症急性胰腺炎并发急性呼吸窘迫综合征32例呼吸道管理体会[J].郑州大学学报:医学版,2008,43(5):1072 [3]Ferguson ND,Fan E,Camporota L,et al.The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material[J].Intensive Care Med,2012,38(10):1573 [4]Li G,Malinchoc M,CartinCeba R,et al.Eightyear trend of acute respiratory distress syndrome: a populationbased study in Olmsted County, Minnesota[J].Am J Respir Crit Care Med,2011,183(1):59 [5]Matthay MA,Zemans RL.The acute respiratory distress syndrome: pathogenesis and treatment[J].Annu Rev Pathol,2011,6:147 [6]Gajic O,Dabbagh O,Park PK,et al.Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study[J].Am J Respir Crit Care Med,2011,183(4):462 [7]Jia X,Malhotra A,Saeed M,et al.Risk factors for ARDS in patients receiving mechanical ventilation for > 48 h[J].Chest,2008,133(4):853 [8]Tremblay LN,Slutsky AS.Ventilatorinduced lung injury: from the bench to the bedside[J].Intensive Care Med,2006,32(1):24 [9]Zochios VA,Wilkinson J.Is lung protective ventilation beneficial for patients without acute respiratory distress syndrome?[J].JAMA,2013,74(12):709 [10]Chang SY,Dabbagh O,Gajic O,et al.Contemporary ventilator management in patients with and at risk of ALI/ARDS[J].Respir Care,2013,58(4):578 [11]Meduri GU,Annane D,Chrousos GP,et al.Activation and regulation of systemic inflammation in ARDS:rationale for prolonged glucocorticoid therapy[J].Chest,2009,136(6):1631 [12]Bonetto C,Terragni P,Ranieri VM.Does high tidal volume generate ALI/ARDS in healthy lungs?[J].Intensive Care Med,2005,31(7):893 [13]Raymondos K,Martin MU,Schmudlach T,et al.Early alveolar and systemic mediator release in patients at different risks for ARDS after multiple trauma[J].Injury,2012,43(2):189 [14]吴晓琴,黄昭,王思荣,等.银杏叶提取物对ARDS氧化应激及炎症的影响[J].中华全科医学,2012,10(8):1184 [15]Determann RM,Royakkers A,Wolthuis EK,et al.Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial[J].Crit Care,2010,14(1):R1

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备注/Memo

备注/Memo:
#通讯作者,男,1964年11月生,教授,主任医师,研究方向:急性肺损伤/急性呼吸窘迫综合征的发病机制及治疗,Email:lihongyuni@126.com
更新日期/Last Update: 1900-01-01