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目的:观察低容量负荷对创伤后急性呼吸窘迫综合征(ARDS)肺功能的保护作用。方法:165例创伤后ARDS患者随机分为液体控制组和对照组,用脉搏指示连续心输出量监测(Pi CCO)指导液体控制,观察中心静脉压(CVP)、肺动脉楔压(PAWP)、氧合指数(Pa O2/Fi O2)、肺泡-肺动脉氧分压差,测定肺泡灌洗液中白细胞介素6(IL-6)水平、血清的肺泡表面活性蛋白D(SP-D)水平的变化,检测呼吸机脱机时间,评估两组患者肺功能的恢复情况。结果:液体控制组血管外肺水肿指数(EVLWI)、CVP、PWAP、IL-6、SP-D以及肺泡-动脉氧分压差均较对照组明显下降(P<0.05),动脉血气氧分压、氧合指数较均对照组明显升高(P<0.05),机械通气支持时间较对照组明显缩短(P<0.05)。结论:严格的液体控制可有效降低人体的容量负荷,有效促进创伤后ARDS肺损伤和肺功能的恢复,这可能与低容量负荷能够降低炎症反应、促进肺泡复张和改善氧合效率有关。
Objective: To observe the protective effect of low volume load on lung function of acute respiratory distress syndrome (ARDS) after trauma. Methods: A total of 165 patients with posttraumatic ARDS were randomly divided into liquid control group and control group. PiCCO was used to guide the fluid control. Central venous pressure (CVP), pulmonary arterial pressure (PAWP), oxygen (Pa O2 / Fi O2), alveolar-pulmonary arterial oxygen pressure difference, the determination of IL-6 level in the bronchoalveolar lavage fluid and the change of serum alveolar surfactant protein D (SP-D) , Detect ventilator off-line time, to assess the recovery of lung function in both groups. Results: Compared with control group, the levels of extravascular pulmonary edema index (EVLWI), CVP, PWAP, IL-6, SP-D and alveolar-arterial oxygen partial pressure in liquid control group were significantly decreased (P < , Oxygenation index was significantly higher than the control group (P <0.05), mechanical ventilation support time significantly shorter than the control group (P <0.05). Conclusions: Strict fluid control can effectively reduce the volume load of the human body and effectively promote the recovery of post-traumatic ARDS lung injury and lung function, which may be related to the low volume load can reduce the inflammatory reaction, promote alveolar recruitment and improve the oxygenation efficiency.