目的 評價高PEEP 機(jī)械通氣策略對ARDS 患者死亡率和氣壓傷發(fā)生率的影響。方法 計算機(jī)檢索PubMed( 1966 年至2008 年9 月) 、EMBASE( 1980 年至2008 年9 月) 、Cochrane Database( 2008 年第2 期) 、中國Cochrane 中心臨床對照試驗(yàn)資料數(shù)據(jù)庫和中國生物醫(yī)學(xué)文獻(xiàn)光盤數(shù)據(jù)庫( 1978 年至2008 年9 月) , 手工檢索初步入選文獻(xiàn)的全文和參考文獻(xiàn)中所列的相關(guān)文獻(xiàn)和雜志、學(xué)術(shù)會議論文集、學(xué)位論文匯編。收集國內(nèi)外關(guān)于不同PEEP 水平機(jī)械通氣策略對ARDS 患者影響的隨機(jī)對照試驗(yàn), 進(jìn)行系統(tǒng)評價。結(jié)果 共5 篇文獻(xiàn)入選, 其中3 篇試驗(yàn)組采用了小潮氣量加高PEEP, 對照組采用了傳統(tǒng)潮氣量加低PEEP 通氣策略, 故歸為一個亞組( A 亞組) ; 2 篇試驗(yàn)組采用了高PEEP,對照組采用了低PEEP, 兩組均采用了小潮氣量通氣策略, 故歸為一個亞組( B 亞組) 。合并結(jié)果顯示, 小潮氣量加高PEEP 通氣策略可以降低A 亞組患者的死亡率[ RR 0. 59, 95%CI( 0. 43, 0. 82) ] 和氣壓傷發(fā)生率[ RR 0. 24, 95%CI( 0. 09, 0. 70) ] , 對B 亞組患者的死亡率[ RR 0. 97, 95%CI( 0. 83, 1. 13) ]和氣壓傷發(fā)生率[ RR 1. 13, 95%CI( 0. 78, 1. 63) ] 無顯著影響。結(jié)論 現(xiàn)有證據(jù)表明, 小潮氣量加高PEEP 通氣策略對ARDS 患者有益, 但單獨(dú)高PEEP 的作用尚需進(jìn)一步評價。
引用本文： 李志強(qiáng),朱波,王長友,邱方. 高呼氣末正壓機(jī)械通氣策略在ARDS患者中應(yīng)用的系統(tǒng)評價. 中國呼吸與危重監(jiān)護(hù)雜志, 2009, 09(3): 279-283. doi: 復(fù)制
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- 1. 萬獻(xiàn)堯, 黃偉, 張久之, 等. 急性呼吸窘迫綜合征機(jī)械通氣患者院內(nèi)死亡的危險因素分析. 中國呼吸與危重監(jiān)護(hù)雜志, 2006, 5: 4-6.
- 2. 秦朝輝, 陳榮昌, 鐘南山. 慢性阻塞性肺疾病患者輔助機(jī)械通氣時呼氣末正壓水平對呼氣末肺容量的影響. 中國呼吸與危重監(jiān)護(hù)雜志, 2007, 6: 23-26.
- 3. Mercat A, Richard JC, Vielle B, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA, 2008, 299:646-655.
- 4. Villar J, Kacmarek RM, Pérez-Méndez L, et al. A high positive endexpiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care Med, 2006, 34 : 1311 -1318 .
- 5. Bugedo G, Bruhn A, Hernández G, et al. Lung computed tomography during a lung recruitment maneuver in patients with acute lung injury. Intensive Care Med, 2003, 29: 218-225.
- 6. Brower RG, Lanken PN, MacIntyre N, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Eng JMed, 2004, 351: 327-336.
- 7. Ranieri VM, Suter PM, Tortorella C, et al. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA, 1999, 282: 54-61.
- 8. Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protectiveventilation strategy on mortality in the acute respiratory distress syndrome. N Eng JMed, 1998, 338: 347-354.
- 9. de Durante G, del Turco M, Rustichini L, et al. ARDSNet lower tidal volume ventilatory strategy may generate intrinsic positive endexpiratory pressure in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med, 2002, 165: 1271-1274.