【摘要】 目的:研究急性呼吸窘迫综合征（ARDS）机械通气中,以呼气末跨肺压为导向来指导呼气末正压（PEEP）设置,从而降低ARDS机械通气中的肺损伤,提高生存率。方法:选取2016年5月—2018年12月在本院住院且明确诊断为中重度的ARDS患者70例,按照随机数字表法将患者分为对照组和治疗组,各35例。对照组以氧饱和度（SaO₂）为依据设置PEEP,治疗组以呼气末跨肺压为标准设置PEEP。比较两组治疗前后的氧合指标（OI、PaO₂、SaO₂、FiO₂）、呼吸力学指标（肺顺应性、呼吸功、呼气末跨肺压、呼气末正压）,以及28 d死亡率、机械通气时间、住院时间。结果:治疗后48、72 h,治疗组OI、PaO₂、SaO₂、肺顺应性、设置的呼气末正压均高于对照组,FiO₂、呼吸功均低于对照组,差异均有统计学意义（P<0.05）。两组呼气末跨肺压在治疗前均为负值,比较差异无统计意义（P>0.05）,治疗后48、72 h,两组比较差异均有统计学意义（P<0.001）。治疗组机械通气时间、住院时间均明显短于对照组,28 d死亡率低于对照组,差异均有统计学意义（P<0.05）。结论:在ARDS肺保护性机械通气中以呼气末跨肺压为导向来指导呼气末压设置的临床效果较传统滴定设置PEEP更精准、优越,能达到预防肺损伤的目标。更多还原

【Abstract】 Objective:To study the setting of positive end-expiratory pressure（PEEP）in mechanical ventilation of acute respiratory distress syndrome（ARDS）guided by end-expiratory transpulmonary pressure,so as to reduce lung injury and improve survival rate in mechanical ventilation of ARDS.Method:From May 2016 to December 2018,70 patients hospitalized in our hospital who were definitely diagnosed as moderate to severe ARDS were selected.According to the random number table method,the patients were divided into the control group and the treatment group,with 35 patients in each group.PEEP was set in the control group based on oxygen saturation（SaO₂）,and in the treatment group based on end-expiratory transpulmonary pressure.Oxygenation indices（OI,PaO₂,SaO₂,FiO₂）respiratory mechanical indices（lung compliance,respiratory work,end-expiratory transpulmonary pressure,end-expiratory positive pressure）before and after treatment,and 28 d mortality rate,duration of mechanical ventilation and hospital stay were compared between the two groups.Result:After 48 and 72 h of treatment,OI,PaO₂,SaO₂,lung compliance and positive end-expiratory pressure in the treatment group were all higher than those in the control group,and FiO₂ and respiratory work were lower than those in the control group,with statistically significant differences（P<0.05）.The terminal expiratory transpulmonary pressure of the two groups was negative before treatment,and the difference was not statistically significant（P>0.05）,48 and 72 h after treatment,the comparison between the two groups was statistically significant（P<0.001）.The duration of mechanical ventilation and hospitalization in the treatment group were significantly shorter than those in the control group,and the mortality on 28 days was lower than that in the control group,with statistically significant differences（P<0.05）.Conclusion:End-expiratory trans-pulmonary pressure is more precise and superior than PEEP in ARDS pulmonary protective mechanical ventilation,which can achieve the goal of preventing lung injury.更多还原