早期应用肌松剂对重度ARDS机械通气患者疗效的影响  

Effect of early application of neuromuscular blocking agents on the treatment of severe ARDS patients with mechanical ventilation

作　　者：冯博[1] 毛峥嵘[1] 

机构地区：[1]河南中医学院第一附属医院重症医学科,河南郑州450000

出　　处：《中国临床研究》2016年第3期305-307,共3页Chinese Journal of Clinical Research

基　　金：河南省中医药科学研究专项课题(2014ZY02029)

摘　　要：目的观察早期应用肌松剂对重度肺内源性急性呼吸窘迫综合征(ARDS)患者机械通气疗效的影响。方法采用回顾性分析方法,选择2015年1月至7月在河南中医学院第一附属医院重症医学科住院的55例行机械通气的重度肺内源性ARDS患者为研究对象,其中插管后联合应用肌松剂(应用时间<48 h)和镇痛、镇静药物的25例为肌松剂组,插管后仅应用镇痛、镇静药物的患者30例为对照组。观察机械通气24 h后两组患者的氧合指数(Pa O2/Fi O2)、肺静态顺应性(Cstat)、平台压(Pplat)及拔管时间、ICU住院时间。结果机械通气24 h后,肌松剂组患者的Pa O2/Fi O2[(152.0±57.0)vs(135.0±43.0),P<0.05)]及Cstat[(32.1±12.2)ml/cm H2O vs(23.1±6.1)ml/cm H2O,P<0.01]高于对照组,Pplat低于对照组[(19.6±6.4)cm H2O vs(26.2±4.0)cm H2O,P<0.01];两组的拔管时间[(6.9±2.9)d vs(7.0±1.3)d]及ICU住院时间[(11.0±7.4)d vs(12.1±1.5)d]比较差异无统计学意义(P均>0.05)。结论早期应用肌松剂可改善机械通气的重度肺内源性ARDS患者的呼吸力学指标及氧合情况,但不影响拔管时间及ICU住院时间。Objective To study the effect of early application of neuromuscular blocking agents（ NBA） on the treatment of severe pulmonary acute respiratory distress syndrome（ ARDS） patients with mechanical ventilation. Methods Fifty-five severe pulmonary ARDS patients received mechanical ventilation in critical care medicine of the first affiliated hospital of Henan university of traditional Chinese medicine from January 2015 to July 2015 were enrolled in this study. The patients treated by NBA（ application time less than 48 hours） combined with sedatives and analgesics after tracheal intubation were defined as neuromuscular blocking agents group（ NBA group,n = 25）. The other 30 patients given sedatives and analgesics only after tracheal intubation were defined as control group. Oxygenation index（ Pa O2/ Fi O2）,pulmonary static compliance（ Cstat）,plateau pressure（ Pplat）,extubation time and ICU stays 24 h after mechanical ventilation were observed in two groups. Results Twenty-four hours after mechanical ventilation,Pa O2/ Fi O2[（ 152. 0 ± 57. 0） vs（ 135. 0 ± 43. 0）,P 〈0. 05） ] and Cstat[（ 32. 1 ± 12. 2） ml / cm H2 O vs（ 23. 1 ± 6. 1） ml / cm H2 O,P 〈0. 01]in NBA group were all significantly higher than those in control group,and Pplat in NBA group was significantly lower than that in control group [（ 19. 6 ±6. 4） cm H2 O vs（ 26. 2 ± 4. 0） cm H2 O,P 〈0. 01]. There were no significant differences in extubation time and ICU days between two groups（ all P 〉0. 05）. Conclusion Early application of NBA can improve the respiratory mechanic indexes and oxygenation status but cannot decrease extubation time and ICU stays in severe pulmonary ARDS patients with mechanical ventilation.

关 键 词：肌松剂 急性呼吸窘迫综合征 肺内源性 机械通气 氧合指数 肺静态顺应性 平台压 拔管时间 

分 类 号：R563[医药卫生—呼吸系统]