目的 評價高PEEP 機械通氣策略對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 中心臨床對照試驗資料數(shù)據(jù)庫和中國生物醫(yī)學文獻光盤數(shù)據(jù)庫( 1978 年至2008 年9 月) , 手工檢索初步入選文獻的全文和參考文獻中所列的相關(guān)文獻和雜志、學術(shù)會議論文集、學位論文匯編。收集國內(nèi)外關(guān)于不同PEEP 水平機械通氣策略對ARDS 患者影響的隨機對照試驗, 進行系統(tǒng)評價。結(jié)果 共5 篇文獻入選, 其中3 篇試驗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, 但單獨高PEEP 的作用尚需進一步評價。
引用本文： 李志強,朱波,王長友,邱方. 高呼氣末正壓機械通氣策略在ARDS患者中應用的系統(tǒng)評價. 中國呼吸與危重監(jiān)護雜志, 2009, 09(3): 279-283. doi: 復制
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| 2. | 秦朝輝, 陳榮昌, 鐘南山. 慢性阻塞性肺疾病患者輔助機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. |
- 1. 萬獻堯, 黃偉, 張久之, 等. 急性呼吸窘迫綜合征機械通氣患者院內(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.