摘要
目的:比较不同跨肺压(PtP)指导下机械通气治疗急性呼吸窘迫综合征(ARDS)患者的疗效。方法:选择2016年10月-2019年2月本院收治的81例ARDS患者为研究对象,根据指导方式及不同PtP水平分为A组(PtP=10 cm H2O)、B组(PtP=20 cm H2O)和对照组(最佳氧合法),每组27例。比较各组机械通气治疗后不同时间点呼吸动力学指标(肺容积、Cst、PIP、Pplat、PEEP)和血流动力学指标(HR、MAP、CVP、CI),同时详细记录各组临床指标。结果:治疗后24、48 h,三组呼吸动力学指标比较,差异均有统计学意义(P<0.05),其中A、B组肺容积、Cst、PIP、Pplat、PEEP均高于对照组(P<0.05)。治疗后24、48 h,三组MAP、CVP、CI比较,差异均有统计学意义(P<0.05),其中B组MAP、CVP、CI均低于对照组(P<0.05);三组治疗前后HR比较,差异均无统计学意义(P>0.05)。B组机械通气治疗时间、住院治疗时间均短于对照组和A组,差异均有统计学意义(P<0.05);A组机械通气治疗时间、住院治疗时间与对照组比较,差异均无统计学意义(P>0.05);三组28 d病死率比较,差异均无统计学意义(P>0.05)。结论:不同PtP指导下机械通气均可改善ARDS患者呼吸功能,但PtP为10 cm H2O指导下机械通气对血流动力学影响较小,建议临床应用中优先使用。
Objective:To compare the efficacy of mechanical ventilation under different trans pulmonary pressure(PtP)in the treatment of acute respiratory distress syndrome(ARDS).Method:A total of 81 cases of ARDS admitted to our hospital from October 2016 to February 2019 were selected as the study objects.According to the guidance method and different PtP levels,they were divided into group A(PtP=10 cm H2O),group B(PtP=20 cm H2O)and control group(optimal oxygen method),27 cases in each group.Respiratory dynamics indexes(pulmonary volume,Cst,PIP,Pplat,PEEP)and hemodynamics indexes(HR,MAP,CVP,CI)of each group were compared at different time points after mechanical ventilation treatment.Meanwhile,the clinical indicators of each group were recorded in detail.Result:At 24 and 48 hours after treatment,the respiratory dynamic indexes of the three groups were compared,the differences were statistically significant(P<0.05),the pulmonary volume,CST,PIP,Pplat,PEEP of group A and B were higher than those of the control group(P<0.05).24 and 48 hours after treatment,MAP,CVP and CI of the three groups were compared,the differences were statistically significant(P<0.05),Map,CVP and CI in group B were lower than those in the control group(P<0.05);there were no significant differences in HR between the three groups before and after treatment(P>0.05).The treatment time and hospitalization time of group B were shorter than those of group A and control group,the differences were statistically significant(P<0.05);the treatment time and hospitalization time of group A were compared with those of the control group,the differences were not statistically significant(P>0.05);there was no significant difference in 28 days mortality among the three groups(P>0.05).Conclusion:Mechanical ventilation under the guidance of different PtP can improve the respiratory function of ARDS patients,but mechanical ventilation under the guidance of PtP of 10 cm H2O has little effect on hemodynamics,so it is recommended to be preferred in clinical application.
作者
徐进林
韩从华
吴振华
许文娟
XU Jinlin;HAN Conghua;WU Zhenhua;XU Wenjuan(Xiantao First People’s Hospital Affiliated to Changjiang University,Xiantao 433000,China)
出处
《中国医学创新》
CAS
2020年第3期13-16,共4页
Medical Innovation of China
关键词
急性呼吸窘迫综合征
跨肺压
机械通气
Acute respiratory distress syndrome
Trans pulmonary pressure
Mechanical ventilation
