两种不同肺复张策略在急性呼吸窘迫综合征治疗中的应用效果比较

发布时间：2018-04-30 05:01

本文选题：急性呼吸窘迫综合征 + 肺复张　；参考：《武汉大学学报(医学版)》2014年06期

【摘要】：目的:研究两种不同肺复张策略在急性呼吸窘迫综合征治疗中的应用效果。方法:选择我院接诊的60例急性呼吸窘迫综合征的患者设计试验进行研究。按照随机数表法,将患者分为A、B两组。A组采用双水平正压通气+压力支持通气模式改良叹气法的肺复张策略对患者实施肺复张,B组采用压力控制法的肺复张策略对患者实施肺复张。分别检测记录两组患者肺复张(RM)前后的各项呼吸指标和血流动力学的变化情况,并记录患者的机械通气时间、ICU住院时间及术后并发症的发生情况。结果:RM前,两组患者的PaO2/FiO2及Cstat无显著性差异(P0.05);RM 30,60min后,患者的PaO2/FiO2及Cstat均较RM前明显升高(P0.05),但两组比较无显著性差异(P0.05);RM 2h后,A组患者的PaO2/FiO2及Cstat的水平明显高于B组,两组比较有显著性差异(P0.05)。RM前,两组患者的HR、MAP、CVP水平均无显著性差异(P0.05);RM 5min后,两组患者的HR、MAP、CVP水平与RM前有显著性差异(P0.05);RM 10min后,A组患者的HR、MAP、CVP水平均得到明显改善,与RM前无显著性差异,B组患者的HR、MAP、CVP水平仍与RM前有显著性差异;RM 20min后,两组患者的HR、MAP、CVP水平与RM前无显著性差异(P0.05)。A组的机械通气时间和ICU住院时间均明显短于B组,两组比较有统计学意义(P0.01)。所有患者在肺复张后,床边正位胸片显示均未发生气胸、纵隔气肿,但A组中合并多器官功能衰竭的患者有2例,B组中合并多器官功能衰竭的患者有3例,两组比较无显著性差异(P0.05)。结论:双水平正压通气+压力支持通气模式改良叹气法对急性呼吸窘迫综合征患者实施肺复张,效果良好,安全性高,值得临床推广应用。
[Abstract]:Objective: to study the effect of two different strategies of pulmonary retension in the treatment of acute respiratory distress syndrome (ARDS). Methods: 60 patients with acute respiratory distress syndrome (ARDS) received in our hospital were studied. According to the random number table method, The patients were divided into two groups: group A and group A. The patients were treated with the strategy of lung reopening with double level positive pressure ventilation and modified sigh method. Group B was treated with the strategy of pulmonary reopening with the method of pressure control. The changes of respiratory index and hemodynamics before and after pulmonary retraction were recorded, and the time of mechanical ventilation, the time of ICU hospitalization and the occurrence of postoperative complications were recorded. Results there was no significant difference in PaO2/FiO2 and Cstat between the two groups before and after 30 minutes. The levels of PaO2/FiO2 and Cstat in group A were significantly higher than those in group B after 30 minutes, but there was no significant difference between the two groups in the levels of PaO2/FiO2 and Cstat in group A. There was no significant difference in the levels of HRP MAPCVP between the two groups before and after P0.05 5min. There was a significant difference between the two groups in the level of HRP MAPP CVP and that in group A (P 0.05) after RM 10min. There was a significant improvement in the level of HRP MAPP CVP in group A after P0.05 10min, and there was no significant difference between the two groups in the level of HRP MAPP CVP in group A after P0.05 5min, and there was a significant difference between the two groups in the level of HRP MAPCVP before and after RM 10min. There was no significant difference in the level of HRP MAPCVP between group B and group B after RM 20min. There was no significant difference between group B and group B before RM. The duration of mechanical ventilation and the hospitalization time of ICU in group A were significantly shorter than those in group B. There was significant difference between the two groups (P 0.01). All the patients had no pneumothorax and mediastinal emphysema on chest radiographs by the bedside after reopening of the lung, but there were 2 patients with multiple organ failure in group A and 3 patients with multiple organ failure in group B. There was no significant difference between the two groups (P 0.05). Conclusion: the modified exclamatory method for patients with acute respiratory distress syndrome by double level positive pressure pressure support ventilation has good effect and high safety. It is worth popularizing in clinic.
【作者单位】：华中科技大学同济医学院附属梨园医院急诊科;华中科技大学同济医学院附属梨园医院儿科;
【分类号】：R563.8

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