| 摘要: |
| 目的 探究气道压力释放通气(Airway Pressure Release Ventilation ,APRV)在重度急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)患者治疗中的临床效果。方法 2018年3月至11月,抽样选取我科收治的重度ARDS患者60例,符合纳入标准,随机分为治疗组(n=30)和对照组(n=30)。两组患者均进行药物祛痰、抗感染、镇痛、镇静、营养支持、小潮气量肺保护性通气(low tidal volume lung protective ventilation, LTV)、振动排痰、纤维支气管镜(简称纤支镜)、肺复张、重症监护等治疗,治疗组氧合指数(PaO2 /FiO2)￡100 mm Hg (1 mm Hg=0.133 KPa)时改为APRV,对照组仍继续使用LTV。观察两组患者氧合指数(PaO2 /FiO2)￡100 mm Hg时及1天(d)后pH、动脉血二氧化碳分压(PaCO2)、PaO2 /FiO2、心率(HR)、平均动脉压(MAP),统计两组患者机械通气时间、重症医学科(ICU)时间及死亡率。结果 入ICU时,两组患者的年龄、HR、MAP、呼吸频率(R)、pH、PaCO2、PaO2 /FiO2等基础资料均无统计学差异(P>0.05)。发展为重度ARDS时与1d后比较,对照组患者pH、PaCO2、PaO2 /FiO2、HR和MAP均无统计学差异(P>0.05),治疗组患者pH、PaCO2、HR、MAP均无统计学差异(P>0.05)。与治疗组重度ARDS时和对照组重度ARDS 1d后比较,治疗组患者APRV 1d后PaO2 /FiO2 [(152.5±36.72)VS(71.3±15.78);(152.5±36.72)VS(73.2±17.29)]均明显升高,且差异统计有意义(P<0.05)。治疗后,两组患者机械通气时间、住ICU时间和死亡人数无统计学差异(P>0.05),治疗组死亡率为53.3%,对照组死亡率为60%。 结论 重度ARDS患者机械通气时使用APRV,能够避免肺损伤发生,改善低氧,且不引起血流动力学改变,为治疗原发病赢得时间,值得临床推广与应用。 |
| 关键词: APRV 机械通气 小潮气量肺保护性通气 ARDS 低氧 |
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| Application of airway pressure release ventilation in the treatment of patients with severe acute respiratory distress syndromeLIU Xiao-yi,LIU Hui,RAN Hui,QIAN Zhu,ZHENG Xiang-de |
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| Abstract: |
| Objective To investigate the clinical effects of airway pressure release ventilation (APRV) in the treatment of patients with severe acute respiratory distress syndrome (ARDS). Methods From March to November 2018, 60 eligible patients with severe ARDS were randomly assigned to intervention group (n=30) or control group (n=30), and meet the inclusion criteria. Expectorant, Anti-infective, analgesic sedation, nutritional support, low tidal volume lung protective ventilation (LTV), vibrating sputum, bronchoscopy , lung recruitment, intensive care and other treatment were conducted in both two groups, but APRV was subsequently performed in the intervention group when PaO2 /FiO2￡100 mm Hg(1 mm Hg = 0.133 KPa). Outcome measurements included pH, PaCO2, PaO2 / FiO2, heart rate (HR) and mean arterial pressure (MAP) when and 1 days after PaO2 /FiO2￡100 mm Hg, and the time of MV and intensive care unit (ICU) stay, and death status. Results When first came to the ICU, there were no significant differences in the age, HR, MAP, respiratory rate (R), pH, PaCO2, PaO2 / FiO2 between the two groups (P>0.05). Compared the time of PaO2 /FiO2￡100 mm Hg with one day after, There was no significant in pH, PaCO2, PaO2/FiO2, HR and MAP in the control group (P>0.05), and no significant difference in pH, PaCO2, HR and MAP in the intervention group (P>0.05). Compared with the time of severe ARDS in the intervention group and the one day after severe ARDS in the control group, the PaO2/FiO2 were Significantly elevated in the intervention group had one day APRV [(152.5±36.72) VS (71.3±15.78); (152.5±36.72) VS (73.2±17.29)] (P < 0.05). After treatment, there was no significant difference between the two groups in mechanical ventilation time, ICU stay time and death toll (P>0.05). The mortality of the intervention group was 53.3%, and the control group was 60%. Conclusions The use of APRV in mechanical ventilation of patients with severe ARDS can avoid lung injury, improve hypoxia, and do not cause hemodynamic changes, win the time to treat the primary disease, with clinical significance. |
| Key words: Airway pressure release ventilation Mechanical ventilation low tidal volume lung protective ventilation Acute respiratory distress syndrome Hypoxia |