西维来司他钠联合小潮气量肺保护性通气对急性呼吸窘迫综合征患者氧合水平及机体炎性反应的影响  

Effect of civelestat sodium combined with low tidal volume lung protective ventilation on oxygenation level and inflammatory response in patients with acute respiratory distress syndrome

作　　者：王磊 李冀 唐娟 陈春蔓 Wang Lei;Li Ji;Tang Juan;Chen Chunman(Department of Critical Care Medicine,Hainan Cancer Hospital,Hainan Province,Haikou 570311,China)

机构地区：[1]海南省肿瘤医院重症医学科,海口570311

出　　处：《疑难病杂志》2023年第2期113-118,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：海南省卫生健康行业科研项目(20A200161)。

摘　　要：目的观察西维来司他钠联合小潮气量肺保护性通气对急性呼吸窘迫综合征(ARDS)患者氧合水平及机体炎性反应的影响。方法选取2021年1月—2022年3月海南省肿瘤医院重症医学科收治ARDS患者96例,按照随机数字表法分为对照组、观察组,各48例。对照组采用小潮气量肺保护性通气治疗,观察组采用西维来司他钠联合小潮气量肺保护性通气治疗。比较2组机械通气时间、入住ICU时间、住院时间,治疗前后血气指标[血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))]、血流动力学指标[心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)]、肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、FEV_(1)/FVC]、炎性因子[白介素-6(IL-6)、C反应蛋白(CRP)、白细胞计数(WBC)],以及不良反应发生率。结果观察组机械通气时间、入住ICU时间、住院时间短于对照组(t/P=6.414/<0.001、3.881/<0.001、5.290/<0.001);治疗后24 h、72 h观察组PaO_(2)、PaO_(2)/FiO_(2)较对照组高,PaCO_(2)较对照组低(F/P=8.451/<0.001、9.785/<0.001、10.265/<0.001);治疗后24 h、72 h 2组HR呈降低趋势,MAP、CVP均呈升高趋势,且同时间点观察组降低/升高较对照组更显著(F/P=18.621/<0.001、25.786/<0.001、26.105/<0.001);治疗后72 h观察组FVC、FEV_(1)、FEV_(1)/FVC高于对照组(t/P=5.971/<0.001、8.649/<0.001、10.404/<0.001);治疗后72 h观察组血清IL-6、CRP、WBC水平低于对照组(t/P=7.887/<0.001、6.168/<0.001、2.879/0.005);2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论西维来司他钠联合小潮气量肺保护性通气可改善ARDS患者血气指标,稳定血流动力学,减轻肺损伤及机体炎性反应,从而改善肺功能,缩短机械通气时间、入住ICU时间及住院时间,安全性高。Objective To observe the effect of civelestat sodium combined with low tidal volume lung protective ventilation on oxygenation level and inflammatory reaction in patients with acute respiratory distress syndrome(ARDS).Methods From January 2021 to March 2022,96 patients with ARDS were selected from the Department of Critical Medicine of Hainan Cancer Hospital.They were divided into control group and observation group according to the method of random number table,with 48 patients in each group.The control group was treated with low tidal volume lung protective ventilation,while the observation group was treated with civelestat sodium combined with low tidal volume lung protective ventilation.Compare the mechanical ventilation,admission to ICU,hospitalization time,blood gas index(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(PaO_(2)/FiO_(2)),hemodynamic index(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary function index(FVC),forced expiratory volume(FEV_(1)),FEV_(1)/FVC)Inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP),white blood cell count(WBC)],and the incidence of adverse reactions.Results The time of mechanical ventilation,admission to ICU and hospitalization in the observation group was shorter than that in the control group(t/P=6.414/<0.001,3.881/<0.001,5.290/<0.001).At 24 and 72 hours after treatment,the PaO_(2),PaO_(2)/FiO_(2)in the observation group were higher than those in the control group,and PaCO_(2)was lower than those in the control group(F/P=8.451/<0.001,9.785/<0.001,10.265/<0.001).At 24 hours and 72 hours after treatment,HR in the two groups showed a downward trend,while MAP and CVP showed an upward trend,and the observation group decreased/increased more significantly at the same time point(F/P=18.621/<0.001,25.786/<0.001,26.105/<0.001).The FVC,FEV_(1),FEV_(1)/FVC in the observation group were higher than those in the control group 72 hours after treatment(t/P=5.971/<0.001、8.649/<0.001、10.404/<0.001).The levels of serum IL-6,CR

关 键 词：急性呼吸窘迫综合征 西维来司他钠 小潮气量肺保护性通气 氧合水平 疗效 

分 类 号：R563.9[医药卫生—呼吸系统]