小潮气量通气序贯肺复张治疗重症急性胰腺炎并发ARDS的临床研究

发布时间：2018-04-24 10:29

本文选题：小潮气量通气 + 肺复张　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:探讨小潮气量通气序贯肺复张(RM)治疗重症急性胰腺炎(SAP)并发ARDS患者的临床效果。方法:选择南昌大学第一附属医院重症监护室(ICU)收治60例SAP并发ARDS病人,按照随机数字法进行分组,分为小潮气量+最佳PEEP组(对照组)和小潮气量+最佳PEEP结合肺复张组(试验组),每组30例。对照组在有效治疗基础上均采用小潮气量控制通气模式(小潮气量(6ml/Kg)+最佳PEEP的通气策略)。当腹腔内压基本正常(I级腹腔高压)时试验组联合肺复张治疗,其余同对照组。通过比较两种机械通气策略治疗下患者的临床效果、观察对比患者不同时间段呼吸力学参数、动脉血气及血流动力学等指标的情况。结果:(1)试验组(肺复张组)重症医学科(ICU)住院时间、机械通气时间、VAP发生率较对照组有所降低,差异有统计学意义(P0.05),而试验组的病死率较对照组稍降低,2组比较差异无统计学意义(P0.05)。(2)试验组(肺复张组)肺静态顺应性(Cst)升高,气道峰压(PIP)、平台压(Pplat)下降,在12、24、48、72 h同时间点2组Cst、PIP、Pplat比较差异有统计学意义(P0.05)。(3)试验组(肺复张组)动脉血Pa02、PaO2/FiO2改善,在12、24、48、72 h同时间点2组Pa02、PaO2/FiO2比较差异有统计学意义(P0.05)。(4)肺复张即刻有一过性血流动力学改变,同肺复张前比较有统计学意义(P0.05),但复张结束5min后差异无统计学意义(P0.05)。结论:以小潮气量+最佳PEEP为基础,当腹腔压力基本恢复正常(I级腹腔高压)后适时应用肺复张手法治疗SAP并发ARDS,与小潮气量机械通气相比更利于改善顺应性和氧合,促进塌陷的肺泡复张,缩短SAP并发ARDS病程和降低VAP发生率。
[Abstract]:Objective: to investigate the clinical effect of small tidal volume ventilation (RM) in the treatment of severe acute pancreatitis (SAP) complicated with ARDS. Methods: sixty patients with SAP complicated with ARDS in intensive care unit of the first affiliated Hospital of Nanchang University were selected and divided into groups according to random number method. They were divided into small tidal volume optimal PEEP group (control group) and small tidal volume optimal PEEP combined with lung expansion group (experimental group, 30 cases in each group). On the basis of effective treatment, the control group all adopted the best ventilation strategy of small tidal volume controlled ventilation mode (small tidal volume of 6 ml / kg). When the intraperitoneal pressure was basically normal, the experimental group combined with the treatment of pulmonary retension, and the others were the same as the control group. By comparing the clinical effects of two mechanical ventilation strategies, the parameters of respiratory mechanics, arterial blood gas and hemodynamics in different time periods were observed and compared. Results the hospitalization time and mechanical ventilation time of ICU in the experimental group (lung retension group) were lower than those in the control group. The difference was statistically significant (P 0.05), but the mortality of the trial group was slightly lower than that of the control group. There was no significant difference between the two groups.) in the experimental group (lung retensiongroup), the static compliance of the lung was increased, the peak airway pressure (PIPP) and the plateau pressure were decreased. There was a significant difference between the two groups at the same time point at 12: 24 and 48 / 72 h. There was a significant difference between the two groups. There was a significant difference between the two groups. There was a significant change in arterial blood Pa02Pao _ (2 / FiO _ 2 / FiO _ 2) in the experimental group (lung retraction group), and there was a significant change in the pulmonary hemodynamics at the same time point (P _ (0.2) Pao _ (2) / FiO _ 2) at the same time point (P _ (0.2) Pao _ (2) / FiO _ (2)) at the same time point (P _ (0.2) Pao _ (2) P _ (0.05)). There was a significant difference between the two groups before and after 5min, but there was no significant difference between the two groups after 5min. Conclusion: on the basis of optimal PEEP of small tidal volume and when the abdominal pressure basically returns to normal grade I abdominal pressure, lung reopening manipulation can be used in the treatment of SAP complicated with ARDS in good time, which is more beneficial to improve compliance and oxygenation than small tidal volume mechanical ventilation. Promote collapsed alveolar extension, shorten the course of SAP complicated with ARDS and reduce the incidence of VAP.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.8;R576

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