急性呼吸窘迫综合征患者早期应用气道压力释放通气的疗效  

Clinical efficacy of early application of airway pressure release ventilation on patients with acute respiratory distress syndrome

作　　者：岳伟岗[1] 向飞 张莹[1] 蒋由飞 袁鹏[1] 冯鑫 尹瑞元 张志刚[1] 李斌[1] Yue Weigang;Xiang Fei;Zhang Ying;Jiang Youfei;Yuan Peng;Feng Xin;Yin Ruiyuan;Zhang Zhigang;Li Bin(Department of Intensive Care Medicine,the First Hospital of Lanzhou University,Lanzhou 730000,China;Department of Medicine Intensive Care Unit,the Third Xiangya Hospital of Central South University,Changsha 410013,China)

机构地区：[1]兰州大学第一医院重症监护病房,兰州730000 [2]中南大学湘雅三医院内科ICU,长沙410013

出　　处：《中华危重症医学杂志（电子版）》2020年第2期93-99,共7页Chinese Journal of Critical Care Medicine:Electronic Edition

摘　　要：目的探讨早期应用气道压力释放通气(APRV)对急性呼吸窘迫综合征(ARDS)患者的临床疗效。方法将2017年9月至2019年6月收住在兰州大学第一医院ICU的71例ARDS患者分为APRV组(36例)和小潮气量(LTV)组(35例)。APRV组患者起初给予容量辅助控制通气模式,测量气道平台压后转为APRV模式;LTV组患者接受LTV通气,目标潮气量设置为6~8 mL/kg,依据ARDSnet协议调节呼气末正压(PEEP)水平、潮气量和呼吸频率。记录两组患者的一般资料,比较其机械通气第1天和第7天呼吸机参数、呼吸力学指标、血气功能指标、循环功能指标及预后情况;绘制Kaplan-Meier生存曲线,比较两组患者28 d生存情况。结果机械通气第7天,APRV组和LTV组患者吸入氧浓度(FiO2)[(47±5)%vs.(66±5)%,t=3.746,P<0.001]、呼吸频率[(24±4)次/min vs.(18±4)次/min,t=3.453,P <0.001]、PEEP[(5.6±2.3)cmH2O vs.(10.8±4.4)cmH2O,t=3.011,P <0.001]、气道峰压[23.9(18.5,29.6)cmH2O vs. 25.1(11.3,31.8)cmH2O,H=2.736,P=0.014]、气道平台压[22.2(18.7,24.3)cmH2O vs. 19.6(17.2,22.4)cmH2O,H=2.154,P=0.023]、平均气道压[23.8(22.1,24.3)cmH2O vs. 15.4(13.9,19.4)cmH2O,H=2.814,P=0.018]、肺顺应性[52.7(37.4,62.3)mL/cmH2O vs. 41.8(31.5,57.6)mL/cmH2O,H=2.008,P=0.034]、动脉血氧分压(PaO2)[(89±7)mmHg vs.(72±7)mmHg,t=2.324,P <0.001]、PaO2/Fi O2[(201±15)mmHg vs.(140±12)mmHg,t=2.743,P <0.001]、动脉血氧饱和度(SaO2)[(95.4±2.1)%vs.(92.3±1.8)%,t=2.658,P <0.001]、心率[(99±9)次/min vs.(108±9)次/min,t=2.733,P=0.014]及平均动脉压[(84±11)mmHg vs.(74±13)mmHg,t=3.012,P=0.011]比较,差异均有统计学意义。APRV组ARDS患者机械通气时间[(9.6±2.2)d vs.(11.9±2.9)d,t=3.687,P <0.001]、住ICU时间[(11.3±3.1)d vs.(13.2±2.7)d,t=2.722,P=0.008]、住院时间[(13.9±2.5)d vs.(16.2±2.4)d,t=3.924,P=0.004]均较LTV组显著缩短,拔管成功率[80.6%(29/36) vs. 54.3%(19/35),χ2=5.592,P=0.018]显著升高,肺复张[5.6%(2/36)vs. 48.6%(17/35),χ2=16.753,P <0.001]、俯卧位通气[11.1%(4/3Objective To investigate the clinical effect of early application of airway pressure release ventilation(APRV)on patients with acute respiratory distress syndrome(ARDS).Methods Seventy-one ARDS patients admitted to the Department of Intensive Care Medicine of the First Hospital of Lanzhou University from September 2017 to June 2019 were divided into a APRV group(n=36)and a low tidal volume(LTV)group(n=35).Patients in the APRV group were initially given a volume-assisted control ventilation mode and then changed to an APRV mode after measuring airway plateau pressure.At the same time,patients in the LTV group were given LTV ventilation.The target tidal volume was set to 6-8 mL/kg,and the positive end expiratory pressure(PEEP)level,tidal volume and respiratory rate were adjusted according to the ARDSnet protocol in the LTV group.The general data of patients in these two groups were recorded,and the ventilator parameters,respiratory mechanics indexes,blood gas indexes,circulation indexes and prognosis were compared after 1 and 7 days of mechanical ventilation.The Kaplan-Meier survival curves were drawn to compare 28-day survival between these two groups.Results After 7 days of mechanical ventilation,the fraction of inspiratory oxygen(FiO2)[(47±5)%vs.(66±5)%,t=3.746,P<0.001],respiratory rate[(24±4)breaths/min vs.(18±4)breaths/min,t=3.453,P<0.001],PEEP[(5.6±2.3)cmH2O vs.(10.8±4.4)cmH2O,t=3.011,P<0.001],peak airway pressure[23.9(18.5,29.6)cmH2O vs.25.1(11.3,31.8)cmH2O,H=2.736,P=0.014],airway platform pressure[22.2(18.7,24.3)cmH2O vs.19.6(17.2,22.4)cmH2O,H=2.154,P=0.023],mean airway pressure[23.8(22.1,24.3)cmH2O vs.15.4(13.9,19.4)cmH2O,H=2.814,P=0.018],lung compliance[52.7(37.4,62.3)mL/cmH2O vs.41.8(31.5,57.6)mL/cmH2O,H=2.008,P=0.034],arterial partial pressure of oxygen(PaO2)[(89±7)mmHg vs.(72±7)mmHg,t=2.324,P<0.001],PaO2/FiO2[(201±15)mmHg vs.(140±12)mmHg,t=2.743,P<0.001],arterial oxygen saturation(SaO2)[(95.4±2.1)%vs.(92.3±1.8)%,t=2.658,P<0.001],heart rate[(99±9)beats/min vs.(108±9)beats/min,t=2.733,P=0.0

关 键 词：气道压力释放通气 小潮气量 急性呼吸窘迫综合征 

分 类 号：R563.8[医药卫生—呼吸系统]