早期无创正压通气联合俯卧位在急性呼吸窘迫综合症治疗中的临床研究  

Clinical Study of Early Non-invasive Positive Pressure Ventilation Combined with Prone Position in the Treatment of Acute Respiratory Distress Syndrome

作　　者：高胜浩 李轩轩 马利军 程剑剑 黄泰博 张婷 忽新刚 尚茜 王东平 李成 李震宇 宋利敏 张晓菊 GAO Shenghao;LI Xuanxuan;MA LiJun;CHENG Jianjian;HUANG Taibo;ZHANGTing;HU Xingang;SHANG Qian;WANG Dongping;LI Cheng;LI Zhenyu;SONGLi min;ZHANG Xiaoju(Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,People's Hospital of Henan University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院呼吸与危重症医学科,郑州大学人民医院,河南大学人民医院,河南省郑州市450003

出　　处：《实用心脑肺血管病杂志》2020年第S01期4-7,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：河南省科技攻关基金项目:俯卧位联合无创正压通气对急性呼吸窘迫综合症的治疗研究(201702193);河南省医学教育研究课题:基于急性呼吸窘迫综合症实施俯卧位通气技术策略在基层专科护士培养中的应用研究(wjlX2019079)

摘　　要：目的探讨无创正压通气(NIPPV)联合俯卧位(PP)在急性呼吸窘迫综合症(ARDS)的临床治疗效果。方法选择2019年10月—2020年2月河南省人民医院呼吸重症监护室(RICU)24例轻中度ARDS患者,依据NIPPV实施先后顺序编号分为对照组与实验组。对照组常规采用NIPPV治疗,实验组采用NIPPV+PP治疗,分别比较两组患者0h、24h时的动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、吸入氧浓度(FiO2)、氧合指数(OI),收缩压(SBP)、舒张压(DBP)、心率(HR)及48h气管插管率、压疮发生率。结果两组患者0h时的PaO2、PaCO2、FiO2、OI、SBP、DBP、HR比较,差异均无统计学意义(P>0.05);治疗24h后两组患者比较显示,实验组PaO2、OI明显改善且高于对照统组,FiO2降低且低于对照组,差异均有计学意义(P<0.05),PaCO2无明显改变,且差异无统计学意义(P>0.05)。48h内对照组与实验组插管率分别为66.7%(8/12)、33.3%(4/12),压疮发生率分别为8.3%、25%。结论NIPPV+PP与单纯NIPPV相比可有效降低轻中度ARDS患者FiO2和NIPPV失败率,改善PaO2和OI,并且早期实施可能有助于避免气管插管。Objective To investigate the clinical effect of non-invasive positive pressure ventilation(NIPPV)combined with prone position(PP)in the treatment of acute respiratory distress syndrome(ARDS).Methods 24 patients with mild to moderate ARDS in respiratory intensive care unit(RICU)of Henan Provincial People's Hospital were divided into control group and experimental group according to the sequence number of NIPPV implementation from October 2019 to June 2020.The control group was treated with NIPPV,while the experimental group was treated with NIPPV+pp.The arterial oxygen partial pressure(PaO2),arterial carbon dioxide partial pressure(PaCO2),inhaled oxygen concentration(FiO2),oxygenation index(OI),systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),intubation rate and pressure sore incidence were compared at 0 h and 24 h respectively.Results PaO2,PaCO2,FiO2,OI,SBP,DBP,HRwere compared between the two groups at 0h,showing no statistically significant difference(P>0.05),but the two groups were comparable.Comparing patients in the two groups at 24h after treatment,PaO2 and OI in the experimental group were significantly improved and higher than those in the control group,FiO2 decreased and lower than the control group,the difference was statistically significant(P<0.05).There was no significant change in PaCO2,no statistically significant difference(P>0.05).The intubation rate was 66.7%(8/12)in the control group and 33.3%(4/12)in the experimental group within 48 hours,and the incidence of pressure sore was 8.3%and 25%respectively.Conclusion Non-invasive positive pressure ventilation combined with prone position can effectively improve PaO2 and OI,reduce FiO2,tracheal intubation and pressure ulcer rates in the patients with mild to moderate ARDS,compared with simple noninvasive positive pressure ventilation.

关 键 词：无创正压通气 俯卧位 急性呼吸窘迫综合征 氧合指数 

分 类 号：R332[医药卫生—人体生理学]