不同氧浓度肺复张对ARDS机械通气患者的影响研究

发布时间：2018-04-22 08:55

本文选题：急性呼吸窘迫征 + 肺复张　；参考：《石河子大学》2016年硕士论文

【摘要】：目的:在对ARDS机械通气患者行肺复张时,观察在4种不同氧浓度条件下ARDS患者肺复张过程中呼吸力学、血气分析、血流动力学指标的变化,探讨不同氧浓度在ARDS患者肺复张时的临床意义,为提出改善并稳定ARDS患者呼吸力学、氧和、血流动力学的最佳肺复张氧浓度提供依据。方法:80例ARDS机械通气患者纳入本试验。将4种不同氧浓度肺复张方法随机实施于每位患者,依次为:A组,给氧浓度(Fi O2)为30%,B组,Fi O2为40%,C组,Fi O2为50%,D组,Fi O2为60%。比较4组ARDS患者肺复张前后不同时间点平台压(Pplat)、气道峰压(Ppeak)、肺复张容积(RV)、肺静态顺应性(Cst)、动脉血氧分压(Pa O2)、动脉血氧饱和度(Sa O2)、动脉血二氧化碳分压(Pa CO2)、酸碱度(PH)、平均动脉压(MAP)、中心静脉压(CVP)和心率(HR)的变化。采用SPSS17.0建立数据库,计量资料以均数±标准差(x±S)表示,不同氧浓度RM的重复测量资料比较采用重复测量资料的方差分析。,以P0.05表明差异有统计学意义。结果:1.对ARDS患者呼吸力学指标的影响:在对4组患者行肺复张前,4组患者呼吸力学指标比较差异无统计学意义(P0.05);肺复张后4组患者肺复张容积(RV)较前明显增加,B组RV增幅大于其他三组,差异均有统计学意义(P0.05);复张后1h,B、C、D三组平台压(Pplat)、气道峰压(Ppeak)较前降低,复张后30min,,B组Pplat、Ppeak和肺静态顺应性(Cst)较前改善,差异均有统计学意义(P0.05),A、C、D组无明显改变,差异无统计学意义(P0.05)。2.对ARDS患者血气分析的影响:在对4组ARDS患者行肺复张前,4组患者Pa O2、Sa O2、Pa O2/Fi O2指标比较,差异无统计学意义(P0.05),肺复张后,4组患者Pa O2、Sa O2、Pa O2/Fi O2指标高于复张前水平,差异有统计学意义(P0.05),在肺复张后各监测时点4组患者Pa O2、Pa O2/Fi O2比较,差异均有统计学意义(P0.05);肺复张前后,4组患者Pa CO2和PH无明显改变(P0.05)。3.对ARDS患者血流动力学的影响:在对4组ARDS患者行肺复张前,4组患者MAP、CVP和HR指标比较,差异无统计学意义(P0.05),在对4组患者行肺复张时,患者MAP指标低于复张前,CVP和HR指标高于复张前,差异均有统计学意义(P0.05),复张后5min,4组患者MAP、CVP和HR指标恢复至原水平。结论:1.不同氧浓度肺复张均可改善ARDS患者呼吸力学指标,提高氧和水平,对血流动力学影响较小。2.采用40%氧浓度肺复张可更快改善ARDS患者Pplat、Ppeak和Cst,更大程度增加RV,在满足氧供的情况下避免了高浓度氧气吸入,达到并维持更好的复张效果。3.在本试验对ARDS患者肺复张的过程中,未出现气压伤、低氧血症等严重并发症,是一种安全有效的治疗措施,且采用40%氧浓度肺复张效果更好,值得临床推广。
[Abstract]:Objective: to observe the changes of respiratory mechanics, blood gas analysis and hemodynamics in patients with ARDS during pulmonary reopening under four different oxygen concentrations. To explore the clinical significance of different oxygen concentrations in the patients with ARDS during pulmonary reopening, and to provide a basis for improving and stabilizing the respiratory mechanics, oxygen and hemodynamics of patients with ARDS. Methods 80 patients with ARDS mechanical ventilation were included in this study. Four different oxygen concentration lung reopening methods were randomly performed in each patient, followed by group A (n = 30), group B (n = 30), group B (n = 30), group C (n = 40), group C (n = 50), group D (n = 50), group D (n = 60). A comparison was made between the four groups of ARDS patients at different time points before and after pulmonary resuscitation, such as plateau pressure, peak airway pressure, pulmonary volume volume, pulmonary static compliance, arterial partial pressure of oxygen (Pao _ 2), arterial oxygen saturation (SAO _ 2), arterial carbon dioxide partial pressure (Paco _ 2), acidity and alkalinity. The changes of mean arterial pressure (MAPP), central venous pressure (CVP) and heart rate (HRV). SPSS17.0 was used to establish the database, and the measurement data were expressed as mean 卤standard deviation (x 卤S). The repeated measurement data of different oxygen concentration RM were compared by the analysis of variance of repeated measurement data. The result is 1: 1. The effect of ARDS on respiratory mechanical indexes: there was no significant difference in respiratory mechanical indexes between the 4 groups before and after pulmonary resuscitation (P 0.05), and the volume of pulmonary retension was significantly increased in the 4 groups after pulmonary reopening compared with the previous group (P < 0.05). Larger than the other three groups, The differences were statistically significant (P 0.05), and the peak airway pressure (Ppeak) and peak airway pressure (Ppeak) were lower in group B than those in group C at 1 h after resuscitation, but there was no significant difference between group B and group C (P 0.05%), but there was no significant difference between group C (P 0.05) and group C (P 0.05 路2) at 30 min after resuscitation, and there was no significant difference between group C (P 0.05) and group C (P 0.05 路2) at 30 min after resuscitation (P > 0.05), but there was no significant difference between group B and group B (P < 0.05). The effect of blood gas analysis on ARDS patients: there was no significant difference in the indexes of PaO2-Sa-O2-O2Pa O2/Fi O _ 2 between four groups of ARDS patients before and after pulmonary reopening, but the level of O2/Fi O _ 2 in four groups of patients after pulmonary reopening was higher than that before re-tensioning. The difference was statistically significant (P 0.05), and there was no significant difference in Pa CO2 and PH between the 4 groups before and after pulmonary resuscitation, and there was no significant difference between the four groups (P 0.05) and PH (P 0.05 路3) before and after the pulmonary resuscitation (P < 0.05), and there was no significant difference between the four groups (P 0.05) before and after the pulmonary resuscitation (P < 0.05). Hemodynamic changes in ARDS patients: there was no significant difference in ARDS and HR between four groups of ARDS patients before and after pulmonary retension.There was no significant difference between the four groups (P 0.05), but there was no significant difference between the four groups when the patients were treated with pulmonary retension.There was no significant difference between the two groups. The MAP and HR of the patients were lower than those of the patients before and after the resuscitation, and the differences were statistically significant (P 0.05). The levels of MAP and HR in the 4 groups recovered to the original level 5 minutes after the reloading. Conclusion 1. Different oxygen concentration can improve respiratory mechanics index, increase oxygen and level, and have little effect on hemodynamics in patients with ARDS. The 40% oxygen concentration of Fu Fu Zhang Ke was used to improve Pplaton Ppeak and CST of ARDS patients more quickly, to a greater extent, to avoid high concentration oxygen inhalation under the condition of oxygen supply, and to achieve and maintain a better effect of retension.3. There were no severe complications such as air pressure injury, hypoxemia and so on in the course of pulmonary retension in patients with ARDS. It is a safe and effective treatment measure, and the effect of 40% oxygen concentration is better, which is worth popularizing in clinic.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R563.8

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