目的 探讨大潮气量机械通气对重型颅脑损伤(TBI)患者呼吸机相关性肺炎(VAP)发生率的影响.方法 重型颅脑损伤需行机械通气的患者40例,无基础肺疾病或肺功能基本正常,随机分2组,大潮气量(VT)组12～15ml/kg(观察组),和小VT组6～10ml/kg(对照组),常规行VAP预防措施,观察7d.比较两组潮气量、气道峰压、呼吸频率、氧合指数、X线胸片,最终观察VAP的发生率.结果 观察组VAP发生率(40％)低于对照组VAP发生率(60％)(P<0.05).两组均未见气胸、严重肺损伤等不良反应.结论 大潮气量显著提高肺动态顺应性,降低肺泡死腔率,减少肺不张,有效降低TBI患者VAP的发生率.%Objective To investigate the effect of high tidal volume mechanical ventilation on ventilator associated pneumonia(VAP) in patients with severe traumatic brain injury. Methods 40 patients required mechanical ventilation for severe traumatic brain injury,no underlying lung disease or lung function was normal,were randomly divided into 2 groups,high tidal volume(VT) was 12～15ml/kg (observation group),and low VT was 6～10ml/kg (control group) and routine VAP preventive measures observation of 7d. The tidal volume,peak airway pressure,respiratory rate,oxygenation index and chest radiograph were compared between the two groups,and the incidence of VAP was finally observed. Results The incidence of VAP in the observation group (40％) was lower than that in the control group,and the incidence of VAP was (60％)(P<0.05). There were no adverse reactions such as pneumothorax or severe lung injury in the two groups. Conclusion High tidal volume significantly increases lung dynamic compliance,decreases alveolar dead space rate,reduces atelectasis,and effectively reduces the incidence of VAP in patients with TBI.
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