【摘要】 目的 研究序贯机械通气对ICU创伤性ARDS患者的效果及对患者炎性细胞、VAP发生率的影响。方法 回顾性分析2017年11月至2019年11月收治的98例创伤性ARDS患者，依据机械通气的方式不同，分为观察组与对照组，观察组49例，采用单纯有创机械通气治疗；对照组49例，采用序贯机械通气治疗。分析2组患者的治疗效、治疗前后炎性细胞因子的变化、呼吸机相关性肺炎（VAP）发生率。结果 治疗后，观察组与对照组PaCO₂水平显著低于治疗前（P<0.05）,观察组也显著低于对照组，差异有统计学意义（P<0.05）;治疗后，观察组与对照组PaO₂水平显著高于治疗前（P<0.05）,观察组也显著高于对照组（P<0.05）,治疗后，观察组与对照组NT-proBNP、TNF-α、IL-6水平均显著低于治疗前（P<0.05）,观察组也显著低于对照组（P<0.05）,观察组的总通气时间、机械通气时间、ICU治疗时间均显著低于对照组（t=17.091,P=0.019;t=13.767,P=0.023;t=15.503,P=0.021）,观察组的VAP、气道损伤发生率显著低于对照组（χ²=23.818,P=0.000;χ²=9.095,P=0.003）。结论 序贯机械通气治疗ICU创伤性ARDS,能够显著改善患者血气参数，降低炎性因子水平，减轻炎性反应，患者VAP、气道损伤发生率也更低，并且在总通气时间、机械通气时间、ICU治疗时间均显著少于单纯有创机械通气组。更多还原

【Abstract】 Objective To investigate the clinical effects of sequential mechanical ventilation for the patients with traumatic ARDS in ICU,and its effects on the inflammatory cells and incidence of ventilator-associated pneumonia（VAP）.Methods A total of 98 patients with traumatic ARDS who were treated in our hospital from November 2017 to November 2019 were enrolled in the study.According to different mechanical ventilation methods, the patients were divided into two groups, with 49 cases in each group.The patients in control group were treated by simple invasive mechanical ventilation, however, those in observation group were treated by sequential mechanical ventilation.The changes of inflammatory cytokines and incidence of VAP were observed and compared between the two groups.Results After treatment, the PaCO₂ levels in both groups were significantly lower than those before treatment, moreover, which in observation group were significantly lower than those in control group（P<0.05）.However the PaO₂ levels in both groups were significantly higher than those before treatment, moreover, which in observation group were significantly higher than those in control group（P<0.05）. After treatment, the levels of NT-proBNP,TNF-α,IL-6 in both groups were significantly lower than those before treatment, moreover, which in observation group were significantly lower than those in control group（P<0.05）.Moreover the total ventilation time, mechanical ventilation time and ICU treatment time in observation group were significantly lower than those in control group（P<0.05）,and the incidence of VAP and airway injury in observation group was significantly lower than that in control group（P<0.05）.Conclusion The sequential mechanical ventilation in treatment of ICU traumatic ARDS can significantly improve the blood gas parameters, reduce the levels of inflammatory factors, relieve the inflammatory reaction, and the incidence of VAP and airway injury, moreover, the total ventilation time, mechanical ventilation time, ICU treatment time are significantly less than those by simple invasive mechanical ventilation.更多还原