“开放肺”复张对烧伤合并吸入性损伤患者急性呼吸窘迫综合征的影响
Influence Of "Open Lung" Recruitment On Ards In Burn Patients With Inhalation Injury.
作者信息
Hung T D, Lam N N
机构信息
National Burns Hospital, Hanoi, Viet Nam.
Medical Military University, Viet Nam.
出版信息
Ann Burns Fire Disasters. 2022 Sep 30;35(3):209-214.
The aim of this study was to determine the safety and impact of open lung strategy ventilation on inhalation injury patients complicated with ARDS. A prospective study was conducted in 33 inhalation injury patients with ARDS who were randomly divided into a control group (ventilated as ARDS net) and a study group (ventilated with open lung strategy). All patients were ventilated with volume control mode until weaning. The results indicated that open lung procedure was safe in most patients with optimal PEEP of 14.31±1.89 cm H2O. Within the first week of ventilation, respiratory system static compliances and PaO2/FiO2 ratio significantly increased in both groups (p<.05) but at a faster rate for the study group (p<.05). Ventilation duration and length of ICU stay were not significantly different across groups (p>.05). Duration time from ARDS onset to death and from admission to death were remarkably longer in the study group (p<.05). However, mortality rate and cause of death were not significantly different within 28 days post burn injury. Open lung recruitment is feasible and could be applied for inhalation injury induced ARDS to improve oxygenation and survival time. Further trials need to be conducted to find out the effectiveness of this strategy on mortality.
本研究的目的是确定肺开放策略通气对合并急性呼吸窘迫综合征（ARDS）的吸入性损伤患者的安全性和影响。对33例合并ARDS的吸入性损伤患者进行了一项前瞻性研究，这些患者被随机分为对照组（按照ARDS网络方案进行通气）和研究组（采用肺开放策略进行通气）。所有患者均采用容量控制模式通气直至脱机。结果表明，在大多数患者中，最佳呼气末正压（PEEP）为14.31±1.89 cm H2O时，肺开放操作是安全的。在通气的第一周内，两组患者的呼吸系统静态顺应性和动脉血氧分压/吸入氧浓度（PaO2/FiO2）比值均显著升高（p<0.05），但研究组升高速度更快（p<0.05）。两组患者的通气时间和重症监护病房（ICU）住院时间无显著差异（p>0.05）。研究组从ARDS发病到死亡以及从入院到死亡的持续时间明显更长（p<0.05）。然而，烧伤后28天内的死亡率和死亡原因无显著差异。肺开放复张是可行的，可应用于吸入性损伤所致的ARDS，以改善氧合和生存时间。需要进行进一步的试验以确定该策略对死亡率的有效性。
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