气道压力释放通气个体化治疗对ARDS患者呼吸机相关性肺损伤的影响

发布时间：2018-11-22 18:46

【摘要】：目的探讨气道压力释放通气个体化治疗(P-APRV)对急性呼吸窘迫综合征(ARDS)患者呼吸机相关性肺损伤(VILI)的影响。方法将44例ARDS患者随机分为同步间歇指令通气(SIMV)组24例、气道压力释放通气(APRV)组20例。SIMV组应用AVEA呼吸机同步间歇指令通气(SIMV)+压力支持(PS)模式通气48 h;APRV组给予P-APRV,根据时间-压力曲线、时间-流速曲线设置APRV参数,通气24 h后复测呼吸曲线并调整参数。分别于入组时及通气24、48 h记录两组呼吸力学指标、血流动力学指标,采用ELISA法测定血清肺损伤生物学标记物肺表面活性蛋白D(SP-D)、唾液酸化大分子黏蛋白(KL-6)。结果通气24、48 h,APRV组呼吸力学指标改善优于SIMV组(P均0.05)。两组通气前后血流动力学指标比较差异无统计学意义(P均0.05)。与通气前比较,通气24、48 h两组血清SP-D、KL-6水平下降(P均0.05),APRV组下降更明显(P均0.05)。结论 P-APRV可减轻ARDS患者呼吸机相关性肺损伤。
[Abstract]:Objective to investigate the effect of individualized airway pressure release ventilation (P-APRV) on (VILI) in patients with acute respiratory distress syndrome (ARDS). Methods 44 patients with ARDS were randomly divided into two groups: (SIMV) group (n = 24), (APRV) group (n = 20), (APRV) group (n = 20). SIMV group was ventilated with AVEA ventilator, (SIMV) pressure support (PS) mode for 48 h. APRV group was given P-APRV. The parameters of APRV were set up according to the time-pressure curve and the time-velocity curve. The respiratory curve was measured 24 hours after ventilation and the parameters were adjusted. The indexes of respiratory mechanics and hemodynamics were recorded at the time of entering the group and at 24 hours after ventilation. Pulmonary surfactant protein D (SP-D) and sialated macromolecular mucin (KL-6) were measured by ELISA method. Results the improvement of respiratory mechanical indexes in APRV group was better than that in SIMV group (P 0.05). There was no significant difference in hemodynamic indexes between the two groups before and after ventilation (P 0.05). Compared with those before ventilation, the serum SP-D,KL-6 level in the two groups decreased significantly (P 0.05) at 48 h after ventilation (all P 0. 05), APRV, P 0. 05). Conclusion P-APRV can alleviate ventilator associated lung injury in ARDS patients.
【作者单位】：河北医科大学第一医院;
【基金】：河北省医学科学研究重点课题(20110305)
【分类号】：R563.8

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