机械通气优化策略对ARDS 患者预后的改善作用

Improvement of Prognosis in ARDS Patients through Optimized Mechanical Ventilation Strategies

Objective: To evaluate the survival outcomes of mechanical ventilation in improving the prognosis of patients with Acute Respiratory Distress Syndrome (ARDS). Methods: A comprehensive search of electronic databases, including PubMed, EMBASE, Cochrane Database, and Chinese Cochrane Clinical Trials Database, as well as the Chinese Biomedical Literature Database, was conducted. Relevant literature, citation lists, professional journals, academic conferences, and theses were manually screened. This study aimed to compare the therapeutic effects of different PEEP levels in mechanical ventilation strategies on ARDS patients. Results: Analysis of five studies revealed that three experiments combined low tidal volume with PEEP, while the control group used conventional tidal volume and low PEEP, classified as Group A. The other two groups used high PEEP, classified as Group B. Summarized analysis of the two groups showed that the strategy of low tidal volume combined with PEEP significantly reduced mortality and the incidence of barotrauma in Group A. Compared to Group B, high PEEP alone did not have a significant impact on mortality and the incidence of barotrauma. Conclusion: Current evidence suggests that the strategy of combining low tidal volume with high PEEP has a positive effect on ARDS patients. However, the exact benefits of high PEEP alone require further research to be confirmed.

目的：针对机械通气对ARDS 患者预后的改善生存效果进行评估分析。方法：通过电子数据库检索，包括PubMed、EMBASE、Cochrane Database 以及中国Cochrane 临床对照试验数据库和中国生物医学文献数据库。手动筛选相关文献的全文、引用列表、专业期刊、学术会议、论文等。以此获取到对不同PEEP 水平机械通气策略研究中对ARDS 患者治疗效果的对比分析。结果：通过纳入5 项研究的分析，得出其中3 项实验都是以小潮气量和PEEP 相结合的方式，其中对照组采用的是常规潮气量和低PEEP 结合的方式，并将这一组归纳为A 组，而另外两组则采用高PEEP的方式，将其归纳为B 组。针对两组汇总分析后，得出相应的数据资料，其中小潮气量加PEEP的策略明显降低了A 组患者的死亡率、气压伤风发生率。和B 组相比较，高PEEP 并未对死亡率和气压伤发生率造成较为显著的影响。结论：在当前现有的证据提示中，可以发现，小潮气量与高PEEP 相结合的通气策略对ARDS 患者有积极影响，但对于高PEEP 独立作用的确切效益，仍需进一步研究证实。