序贯通气对于急性胰腺炎所致急性呼吸窘迫综合征的临床效果  

Clinical value of sequential mechanical ventilation in patients with acute respiratory distress syndrome caused by severe acute pancreatitis

作　　者：杜友谊[1] 吕祝庆[1] 孙德彬[1] 周家峰[1] 孙蕾[1] 

机构地区：[1]丽水市中心医院呼吸内科,323000

出　　处：《国际呼吸杂志》2013年第4期270-272,共3页International Journal of Respiration

摘　　要：目的研究序贯通气对于急性胰腺炎所致急性呼吸窘迫综合征的临床效果。方法将我院ICU于2009年5月至2011年5月期间收治的72例由于急性胰腺炎所致的急性呼吸窘迫综合征患者作为研究对象，将所有患者按照随机分组原则分为治疗组（序贯通气组）与对照组（机械通气组），各36例，其中治疗组采用序贯通气法治疗，对照组采用普通机械通气法治疗。对比两组患者于治疗前、治疗后16h及拔管时PaO2、PaCO2、pH值以及无创通气时间、机械通气时间、死亡率、治愈率及不良反应发生率。结果①序贯通气组有创通气时间为（2．34±1．24）d，少于机械通气组有创通气时间[（5．21±2．32）d，t=3．230，P〈0．053；②序贯通气组总机械通气时间为（4．38±2．15）d，与机械通气组总机械通气时间[（4．25±2．35）d]比较差异无统计学意义（t=3．230，P〉0．05）；③序贯通气组于治疗后16hpH平均值恢复正常，PaO2高于机械通气组（t=3．440，P〈0．05），PaCO2亦高于机械通气组（t=5．125，P〈0．05）；④序贯通气组呼吸机相关性肺炎发生率为8．3％，低于机械通气组（16．7％，χ^2=15．644，P〈0．05）；⑤序贯通气组治愈率（86．1％）高于机械通气组（75．0％），且不良反应发生率、死亡率均低于机械通气组。结论使用有创一无创序贯通气治疗急性胰腺炎所致急性呼吸窘迫综合征，具有缩短有创通气时间、动脉血气水平恢复快、不良反应少、治愈率高等优点，值得于临床广泛推广使用。Objective To investigate effect of invasive-noninvasive sequential mechanical ventilation on treating patients with acute respiratory distress syndrome caused by severe acute pancreatitis. Methods 72 cases of acute respiratory distress syndrome caused by severe acture pancreatitis in our hospital from May 2009 to May 2011 were randomly divided into two groups with 36 cases in each： treatment group （sequential mechanical ventilation group） and control group （invasive ventflation group）. PaO2, PaCO2, and pH were measured before treatment and 16 hours after treatment in both groups. The mechanical ventilation duration,case fatality,curative ratio,side effect incidence were analyzed. Results The invasive ventilation duration in treatment group [（2.34±1.24） days was shorter than that in control group [（5.21±2.32） days, t = 3. 230, P d0.05]. There was no statistical significance in total mechancial ventilation duriation between two groups [（4.38±2.15） days vs （4.25±2.35） days, t =3. 230, P 0.05]. The level of pH was improved at 16th hour in treatment group. The level of PaO2 in treatment group was superior to that in control group （ t =3. 440, P 〉0.05） ,and PaCO2 was superior too （ t = 5. 125, P 0.05）. The incidence of vetilation associated pneumonia in treatment group was lower than that in control group （8.3% vs 16.7%, ）{2 = 15. 644, P 〈0.05）. Moreover, the curative ratio in treatment group （86.1%） was higher than that in conrol group （75.0%）. Conclusions The invasive-noninvasive sequential mechanical ventilation is more effective in patients with acute respiratory distress syndrome caused by severe aetue pancreatitis by shortening the time of invasive ventilation duration and decreasingthe incidence and case fatality of ventilation associated pneumo, nia.

关 键 词：序贯通气 急性胰腺炎 急性呼吸窘迫综合征 

分 类 号：R563.8[医药卫生—呼吸系统]