早期应用肌松剂联合机械通气治疗中重度急性呼吸窘迫综合征的临床效果  

Clinical effect of early application of muscle relaxant combined with mechanical ventilation in the treatment of moderate to severe acute respiratory distress syndrome

作　　者：宋德彬 黎代强 黄敬应 黄营 SONG Debin;LI Daiqiang;HUANG Jingying;HUANG Ying(Intensive Care Unit,Hezhou People's Hospital of Guangxi Zhuang Autonomous Region,Guangxi,Hezhou 542899,China)

机构地区：[1]广西壮族自治区贺州市人民医院重症医学科,广西贺州542899

出　　处：《中国医药科学》2020年第20期108-111,共4页China Medicine And Pharmacy

摘　　要：目的探讨早期应用肌松剂联合机械通气治疗中重度急性呼吸窘迫综合征(ARDS)的临床效果。方法将我院2019年1月~2020年4月ICU接收的中重度ARDS患者80例随机分为对照组与观察组,每组各40例。两组均行机械通气,对照组采用安慰剂芬太尼静脉滴注,观察组自患者入ICU后应用肌松药物顺阿曲库铵连续微泵静脉注射48h。对比两组患者的APACHEⅡ评分、ICU病死率、ICU获得性肌无力(ICUAW)、呼吸机相关性肺损伤(VILI)、人-机对抗及机械通气时间、住院时间。结果两组患者入ICU 48h的APACHEⅡ评分均低于入ICU时(P<0.01);观察组入ICU 48h的APACHEⅡ评分低于对照组(P<0.01)。观察组ICUAW发生率与对照组比较,差异无统计学意义(P>0.05);观察组ICU病死率、VILI及人-机对抗发生率均低于对照组(P<0.05)。观察组机械通气时间、ICU住院时间均短于对照组(P<0.05)。结论早期应用肌松剂联合机械通气治疗中重度ARDS可更好地降低APACHEⅡ评分,进而降低ICU病死率、VILI、人-机对抗发生率,缩短机械通气时间和ICU住院时间,且不会增加ICU获得性肌无力发生率。Objective To explore the clinical effect of early application of muscle relaxant combined with mechanical ventilation in the treatment of moderate to severe acute respiratory distress syndrome(ARDS).Methods A total of 80 patients with moderate to severe ARDS received in the ICU from January 2019 to April 2020 in our hospital were taken as the research objects,and they were randomly divided into a control group and an observation group,with 40 cases in each group.Both groups were given mechanical ventilation.The control group was treated with intravenous drip of placebo fentanyl,while the observation group was treated with intravenous injection of muscle relaxant cisatracurium with micro-pump for 48 h after the patient was admitted to the ICU.APACHEⅡscore,ICU mortality,ICU-acquired weakness(ICUAW),ventilator-induced lung injury(VILI),patient-ventilator asynchrony,duration of mechanical ventilation,and length of stay were compared between the two groups.Results The APACHEⅡscores of both groups were lower at 48 h after admission to the ICU than that at admission to the ICU(P<0.01).The APACHEⅡscore of the observation group was lower than that of the control group at 48 h after admission to the ICU(P<0.01).There was no significant difference in the incidence of ICUAW between the observation group and the control group(P>0.05).The ICU mortality,VILI and incidence of patient-ventilator asynchrony were lower in the observation group than those in the control group(P<0.05).The duration of mechanical ventilation and length of ICU stay were lower in the observation group than those in the control group(P<0.05).Conclusion Early application of muscle relaxant combined with mechanical ventilation in the treatment of moderate to severe ARDS can better reduce the APACHEⅡscore,ICU mortality,VILI,and the incidence of patient-ventilator asynchrony and shorten the duration of mechanical ventilation and length of ICU stay,without significantly increasing the incidence of ICUAW.

关 键 词：早期 肌松剂 机械通气 中重度 急性呼吸窘迫综合征 

分 类 号：R563.8[医药卫生—呼吸系统]