摘要
目的探讨机械通气联合俯卧位通气治疗重度急性呼吸窘迫综合征(ARDS)的临床效果及安全性。方法选择2023年1月至2024年3月该院收治的89例重度ARDS患者作为研究对象,根据治疗方法不同分为2组。对照组(45例)采用机械通气治疗,观察组(44例)采用机械通气联合俯卧位通气治疗,治疗7 d后评估2组疗效,比较2组呼吸功能气道平均压(Pmean)、气道峰压(Ppeak)、肺动态顺应性(Cdyn)、肺泡-动脉氧分压[P(A-a)DO_(2)]、血流动力学指标[心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)]、炎症因子[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)]、并发症发生情况及近期病死率。结果干预后,2组Pmean、Ppeak、P(A-a)DO_(2)较干预前降低,Cdyn较干预前升高,观察组Pmean、Ppeak、P(A-a)DO_(2)低于对照组,Cdyn高于对照组,差异均有统计学意义(P<0.05)。干预后,2组HR、MAP较干预前升高,CVP较干预前降低,观察组HR、MAP低于对照组,CVP高于对照组,差异均有统计学意义(P<0.05)。干预后,2组IL-6、IL-10、TNF-α较干预前水平均降低(P<0.05),观察组IL-6、IL-10、TNF-α水平低于对照组(P<0.05)。2组并发症总发生率比较,差异无统计学意义(P>0.05)。观察组近期病死率低于对照组(P<0.05)。结论机械通气联合俯卧位通气用于重度ARDS患者,能改善患者呼吸功能,对血流动力学影响较小,并降低炎症因子水平及近期病死率,且未增加并发症发生率,值得临床推广应用。
Objective To investigate the clinical efficacy and safety of mechanical ventilation combined with prone positioning ventilation in the treatment of severe acute respiratory distress syndrome(ARDS).Methods A total of 89 patients with severe ARDS admitted to the hospital from January 2023 to March 2024 were selected as study subjects.Based on different treatment approaches,they were divided into two groups.The control group(45 cases)received mechanical ventilation,while the observation group(44 cases)received mechanical ventilation combined with prone positioning ventilation.After 7 d of treatment,efficacy of the two groups was assessed.Respiratory function indices including mean airway pressure(Pmean),peak airway pressure(Ppeak),dynamic lung compliance(Cdyn)and the alveolar-arterial oxygen partial pressure gradient[P(A-a)DO_(2)];hemodynamic parameters including heart rate(HR),central venous pressure(CVP)and mean arterial pressure(MAP);inflammatory cytokines including interleukin-6(IL-6),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α);as well as the incidence of complications and short-term mortality were compared between the two groups.Results After the intervention,Pmean,Ppeak and P(A-a)DO_(2) were reduced compared with before intervention,whereas Cdyn was increased compared with before intervention in both groups(P<0.05).Pmean,Ppeak and P(A-a)DO_(2) were significantly lower,and Cdyn was significantly higher in the observation group compared with those in the control group,and the differences were statistically significant(P<0.05).Following the intervention,HR and MAP were elevated compared with before intervention,and CVP was decreased compared with before intervention in both groups(P<0.05).HR and MAP were significantly lower,and CVP was significantly higher in the observation group than those in the control group,and the differences were statistically significant(P<0.05).After treatment,the serum levels of IL-6,IL-10 and TNF-αwere significantly decreased compared with before intervention in both groups(P<0.05),and these cytokines were significantly lower in the observation group than those in the control group(P<0.05).No significant difference was observed in the total incidence of complications between the two groups(P>0.05).The short-term mortality rate was significantly lower in the observation group than that in the control group(P<0.05).Conclusion Mechanical ventilation combined with prone positioning ventilation in patients with severe ARDS can improve respiratory function,exert minimal effects on hemodynamics,reduce inflammatory cytokine levels and short-term mortality,and does not increase the incidence of complications.This combined approach is worthy of clinical application and promotion.
作者
杜文辉
王明明
赵红艳
李豆敏
DU Wenhui;WANG Mingming;ZHAO Hongyan;LI Doumin(Department of Critical Care Medicine,Central Hospital of Tongchuan Mining Bureau,Tongchuan,Shaanxi 727000,China)
出处
《检验医学与临床》
2025年第24期3383-3387,共5页
Laboratory Medicine and Clinic
基金
陕西省卫生健康委员会科研基金项目(2022D037)。
关键词
急性呼吸窘迫综合征
机械通气
俯卧位通气
安全性
白细胞介素-6
acute respiratory distress syndrome
mechanical ventilation
prone positioning ventilation
safety
interleukin-6
