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急性肺损伤无论体重如何最好予低潮气量通气

来源:www.medcyber.com
摘要:2004年3月2日《内科学年鉴》(AnnalsofInternalMedicine)上的一项再次分析表明,低潮气量通气对急性肺损伤的超重和肥胖病人的益处与对正常体重者相似。Brien)和国立心、肺和血液研究所(NHLBI)的同行写道,“有人认为高潮气量通气对需要呼吸机的肥胖病人有益”。他们检查了10家医疗中心招募来参加随机对照试验的90......

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2004年3月2日《内科学年鉴》(Annals of Internal Medicine)上的一项再次分析表明,低潮气量通气对急性肺损伤的超重和肥胖病人的益处与对正常体重者相似。

“尽管成人的肥胖很流行,但超重对重症病人后果的影响还没得到很好研究”,美国科罗拉多大学的奥伯利恩(James M. O'Brien)和国立心、肺和血液研究所(NHLBI)的同行写道,“有人认为高潮气量通气对需要呼吸机的肥胖病人有益”。

他们检查了10家医疗中心招募来参加随机对照试验的902名急性肺损伤病人的资料:这些试验指定病人或接受较高(12ml/kg)或较低潮气量(6ml/kg)通气,部分人还使用了酮康唑、己酮可可碱或安慰剂。与体重正常的病人相比,肥胖病人肺损伤如创伤的间接原因更多。试验开始前,超重和肥胖病人因为设置的潮气量较高,气道平台压力更高。结果表明,体重与调整死亡危险增加、实现停用呼吸机或不用呼吸机的时间无关。

“超重和肥胖急性肺损伤病人的后果与体重指数(body mass index,BMI)正常者相似”,作者写道,“这表明低潮气量对他们都有益”。“医生不应想当然地认为肥胖病人的状况差于正常病人”,他们说,但“将来还要研究对其它重症病人,过重是否增加了后果不良的危险”。

Ann Intern Med. 2004 Mar 2;140(5):338-45.

Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury.

O'Brien JM Jr, Welsh CH, Fish RH, Ancukiewicz M, Kramer AM; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network.

University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.

BACKGROUND: Despite an epidemic of obesity among adults, the effect of excess body weight on outcome from critical illness is not well studied. OBJECTIVE: To examine the association between excess body weight and outcome in mechanically ventilated patients with acute lung injury. DESIGN: Secondary analysis of participants in trials of therapy for acute lung injury. SETTING: 10 U.S. medical centers that participate in the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network. PATIENTS: 902 mechanically ventilated patients who were enrolled in randomized, controlled trials of therapy for acute lung injury. INTERVENTION: Assignment to higher (12 mL/kg of predicted weight) or lower (6 mL/kg of predicted weight) tidal volume ventilation strategies with specified weaning protocols. Some patients also received ketoconazole, lisofylline, or placebo by factorial design. MEASUREMENTS: Mortality rate, rate of unassisted ventilation by day 28, and number of ventilator-free days. RESULTS: Indirect causes of lung injury, including trauma, were more common in obese patients. Overweight and obese patients had higher peak and plateau airway pressures before enrollment because of higher set tidal volumes. After risk adjustment, excess body weight was not associated with death, achievement of unassisted ventilation, or number of ventilator-free days. This lack of effect persisted with categorical or continuous measures of body mass index (BMI). We found no significant interaction between ventilator protocol assignment and BMI category. CONCLUSIONS: After risk adjustment, overweight and obese patients with acute lung injury have outcomes similar to those of patients with normal BMI. The lack of interaction between ventilator protocol assignment and BMI suggests that patients with normal, overweight, or obese BMI benefit from lower tidal volume ventilation for acute lung injury.

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作者: 自动采集 2005-2-23
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