气道压力释放通气救治急性呼吸窘迫综合征患者疗效观察  

Observation on the curative effect of airway pressure release ventilation in the treatment of patients with acute respiratory distress syndrome

作　　者：滕泽宇 梁映霞[1] 闫早红 张传振 张成明[3] Teng Zeyu;Liang Yingxia;Yan Zaohong;Zhang Chuanzhen;Zhang Chengming(School of Anesthesiology,Weifang Medical University,Shandong Province,Weifang 261053,China;不详)

机构地区：[1]潍坊医学院麻醉学院,261053 [2]潍坊医学院附属医院重症医学科 [3]潍坊医学院附属医院麻醉科

出　　处：《疑难病杂志》2022年第7期706-710,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：山东省自然科学基金资助项目(ZR2020MH130)。

摘　　要：目的观察急性呼吸窘迫综合征(ARDS)患者使用气道压力释放通气(APRV)的疗效。方法选取2019年11月—2021年9月于潍坊医学院附属医院重症医学科(ICU)收治的ARDS患者61例作为研究对象。按照随机数字表法分为APRV组31例和低潮气量通气组(LTV)30例,APRV组接受APRV通气,LTV组接受LTV肺保护通气。比较治疗前与治疗后第3天循环指标[心率、平均动脉压(MAP)]、自主呼吸频率、动脉血气指标[动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))、氧合指数]、呼吸力学指标[呼吸系统顺应性(Crs)、平台压(Pplat)、平均气道压(Pmean)、吸气峰压(PIP)],以及Ramsay镇静评分。结果治疗第3天APRV组心率低于LTV组,MAP高于LTV组(t/P=3.241/0.002、2.699/0.009),自主呼吸频率比较差异无统计学意义(P>0.05);APRV组氧合指数、PaO_(2)均高于LTV组(t/P=3.651/0.001、2.815/0.007),PaCO_(2)比较差异无统计学意义(P>0.05);APRV组Crs、Pmean高于LTV组,Pplat、PIP低于LTV组(t/P=3.687/0.001、5.096/<0.001、3.154/0.003、2.498/0.016);APRV组Ramsay镇静评分低于LTV组(t/P=3.396/0.002)。结论APRV对比LTV模式使ARDS患者氧合、呼吸力学指标及循环功能得到更好改善且镇静需求降低,舒适度相对提高。Objective To observe the efficacy of airway pressure release ventilation(APRV)in patients with acute respiratory distress syndrome(ARDS).Methods A total of 61 ARDS patients admitted to the Intensive Care Unit(ICU)of the Affiliated Hospital of Weifang Medical College from November 2019 to September 2021 were selected as the research subjects.According to the random number table method,they were divided into APRV group(31 cases)and low tidal volume ventilation(LTV)group(30 cases).APRV group received APRV ventilation,and LTV group received LTV lung protection ventilation.Circulation indexes[heart rate,mean arterial pressure(MAP)],spontaneous breathing frequency,arterial blood gas indexes[arterial partial pressure of oxygen(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),oxygenation index were compared before and after treatment],respiratory mechanics indexes[respiratory system compliance(Crs),plateau pressure(Pplat),mean airway pressure(Pmean),peak inspiratory pressure(PIP)],and Ramsay sedation score.Results On the third day of treatment,the heart rate of APRV group was lower than that of LTV group,and the MAP was higher than that of LTV group(t/P=3.241/0.002,2.699/0.009),and there was no significant difference in spontaneous breathing frequency(P>0.05).Index and PaO_(2) were higher than those in LTV group(t/P=3.651/<0.001,2.815/0.007),and there was no significant difference in PaCO_(2)(P>0.05);Crs and Pmean in APRV group were higher than those in LTV group,while Pplat and PIP were lower in APRV group In LTV group(t/P=3.687/0.001,5.096/<0.001,3.154/0.003,2.498/0.016);APRV group Ramsay sedation score was lower than LTV group(t/P=3.396/0.002).Conclusion Compared with LTV mode,APRV can better improve oxygenation,respiratory mechanics and circulatory function in ARDS patients,reduce the need for sedation,and improve comfort relatively.

关 键 词：急性呼吸窘迫综合征 气道压力释放通气 自主呼吸 动脉血气指标 呼吸力学指标 

分 类 号：R563.9[医药卫生—呼吸系统]