张妮

[摘要] 目的 探讨肺保护性通气和肺复张相结合的机械通气策略，加强液体管理等综合治疗急性呼吸窘迫综合征疗效。 方法 42例患者均为我院ICU病房收治，收集时间为2008年7月～2012年4月间，随入院先后分为对照组与观察组各21例，对照组选择传统正压通气加传统体液调节，观察组选择综合治疗。观察两组治疗前后血气分析结果及并发症、死亡率。 结果 治疗24 h后，两组患者PaO2、PaCO2、PaO2/FiO2结果均有明显变化，各项与治疗前对比，差异有统计学意义（P<0.05）；两组治疗后乳酸含量、并发症及死亡率对比，差异有统计学意义（P<0.05）。 结论 通过肺复张与保护性通气相结合，加强液体管理的方式治疗ARDS，可有效减少并发症的发生，降低患者死亡率，效果显著，值得临床推广应用。

[关键词] 急性呼吸窘迫综合征；机械通气；液体管理；乳酸

[中图分类号] R563.8 [文献标识码] B [文章编号] 1673-9701（2017）14-0066-04

[Abstract] Objective To explore the efficacy of combined treatment of pulmonary ventilation and pulmonary reexpansion to strengthen the comprehensive treatment of liquid management in acute respiratory distress syndrome. Methods A total of 42 patients were all admitted to our hospital ICU ward from July 2008 to April 2012. And the patients were divided into the control group （n=21） and the observation group （n=21） according to the order of admission. The control group was given traditional positive pressure ventilation plus traditional body fluid adjustment， and the observation group was given comprehensive treatment. The results of blood gas analysis， complications and mortality were observed in the two groups before and after treatment. Results After treatment for 24 h， the results of PaO2， PaCO2 and PaO2/FiO2 were significantly changed in the two groups， and the difference in each item was significant between before and after treatment （P<0.05）. There were significant differences in the lactic acid content， complication and mortality between the two groups after treatment（P<0.05）. Conclusion In conclusion， it is effective to reduce the incidence of complications and the mortality of patients by combining lung resuscitation and protective ventilation to strengthen liquid management in the treatment of ARDS. It is worthy of clinical application.

[Key words] Acute respiratory distress syndrome； Mechanical ventilation； Liquid management； Lactic acid

急性呼吸窘迫綜合征（acute respiratory distress syndrome，ARDS）是一种以进行性呼吸困难并且伴有顽固性的低氧血症为特征的疾病，可被肺部感染、胸部外伤、脓毒血症、胰腺炎以及休克等多种病因诱发，发病致死率高达49%，严重影响患者的生活质量[1]。基于以上背景，本研究整理分析我院此类疾病患者病例，探讨发现急性呼吸窘迫征发病早期给予患者呼吸机供氧、处理和预防呼吸道肺部等感染、运用肺复张和肺保护性透气结合联用的治疗策略，效果显著，现报道如下。

1 资料与方法

1.1 一般资料

选择我院重症加强护理病房在2008年7月～2012年4月间收治的急性呼吸窘迫综合征患者共42例，随机均分为两组，即观察组和对照组。其中对照组：女6例，男15例，平均年龄（39.36±9.61）岁，发病时间72 h以内。观察组：女5例，男16例，平均年龄（42.30±8.36）岁，发病时间72 h以内。其中，脓毒血症患者3例，休克患者4例，胸部外伤以及多发伤患者3例，肺部感染患者26例。……