俯卧位联合肺复张治疗百草枯中毒引起的ARDS效果观察  

Therapeutic effects of prone position combined with lung recruitment in treatment of ARDS in patients with paraquat poisoning

作　　者：许运铎 张晓博[2] 耿丽华 陈凤兰[2] 鲍倩 白雪景 张桂荣[2] 张桂英[2] XU Yunduo;ZHANG Xiaobo;GENG Lihua(The Tow People’s Hospital of Hengshui City,Hebei,Hengshui 053000,China)

机构地区：[1]河北省衡水市第二人民医院,053000 [2]河北省衡水市第四人民医院,053000 [3]河北省衡水市中心血站

出　　处：《河北医药》2020年第21期3314-3317,共4页Hebei Medical Journal

摘　　要：目的研究百草枯中毒引起的急性呼吸窘迫综合征(ARDS)患者俯卧位通气联合肺复张的临床效果。方法选取2017年12月至2019年12月急诊科、重症医学科收治的百草枯中毒所致ARDS患者35例,患者随机分为观察组18例和对照组17例,患者均行气管插管及有创机械通气。观察组每天进行俯卧位≥16 h,同时每12小时进行1次肺复张(采用PEEP递增法);对照组持续行有创机械通气,直至脱机。记录2组有创通气时间、氧和指数、平均住院时间、呼吸机相关性肺炎(VAP)发生率、病死率情况。结果观察组明显改善肺部氧和情况,缩短有创通气时间和平均住院天数(P<0.05),但是对患者发生呼吸机相关性肺炎、多器官功能障碍均无明显改善(P>0.05)。2组的病死率差异无统计学意义(P>0.05)。结论百草枯中毒引起的ARDS患者应积极实施肺开放策略,对实现塌陷肺泡的复张具有重要临床意义;在机械通气条件下,俯卧位通气联合肺复张的通气策略可使患者尽早脱离呼吸机,患者可尽早获得生理性的肺复张的机会,减少机械通气时的并发症,缩短有创机械通气时间和平均住院时间。Objective To investigate the therapeutic effects of prone position ventilation combined with lung recruitment for the patients with acute respiratory distress syndrome(ARDS)caused by paraquat poisoning.Methods A total of 35 patients with ARDS caused by paraquat poisoning who were admitted and treated in our hospital from December 2017 to December 2019 were enrolled in the study,who were randomly divided into observation group(n=18)and control group(n=17).The patients in both groups underwent tracheal intubation and invasive mechanical ventilation.The patients in observation group performed prone position for more than 16 hours per day,at the same time,who underwent lung recruitment at an interval of 12 hours(PEEP incremental method).The patients in control group were treated by continued invasive mechanical ventilation until offline.The invasive ventilation time,oxygen saturation index,average hospital stay,and the incidence and mortality of ventilator-associated pneumonia(VAP)were observed and compared between the two groups.Results The invasive ventilation time,oxygen saturation index,average hospital stay in observation group were significantly improve(P<0.05),however,there were no significant changes in the incidence of ventilator-associated pneumonia and multiple organ dysfunction(P>0.05).There was no significant difference in the mortality rate between the two groups(P>0.05).Conclusion To actively perform the strategy of opening the lungs to achieve the recruitment of collapsed alveoli for the patients with ARDS caused by paraquat poisoning has important clinical significance.Under the condition of mechanical ventilation,the ventilation strategy of prone position ventilation combined with lung recruitment can make the patient get out of the ventilator as early as possible,reduce invasive ventilation time and average hospital stay as well as the incidence of complications.

关 键 词：百草枯中毒 有创机械通气 急性呼吸窘迫综合征 俯卧位通气 肺复张 

分 类 号：R595.4[医药卫生—内科学]