液体负平衡治疗重型颅脑损伤合并急性呼吸窘迫综合征患者临床观察  

Clinical observation of negative fluid balance therapy on patients with severe craniocerebral injury combined with acute respiratory distress syndrome

作　　者：王文涛[1] 秦绍杰 雷汶璐 郭燕[1] 祁绍艳[1] 刘小军[1] WANG Wentao;QIN Shaojie;LEI Wenlu;GUO Yan;QI Shaoyan;LIU Xiaojun(The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]郑州大学第二附属医院,河南郑州450003

出　　处：《中国实用神经疾病杂志》2023年第2期165-169,共5页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关联合共建项目(编号:LHGJ20200419)。

摘　　要：目的探讨液体负平衡治疗对重型颅脑损伤合并急性呼吸窘迫综合征(ARDS)患者机械通气情况、氧合状况及血流动力学指标的影响。方法回顾性分析郑州大学第二附属医院2019-10—2021-12收治的83例重型颅脑损伤合并ARDS患者为研究对象,对照组41例给予常规治疗,观察组42例在常规治疗的基础上采用液体负平衡治疗,对比2组患者治疗前后机械通气情况[(吸入氧浓度(FiO_(2))、平台压(Pplat)、呼气末正压(PEEP)、呼吸机使用时间)],氧合状况[治疗前后氧分压(PaO_(2))、肺泡-动脉氧分压差[P(A-a)O_(2)]、氧合指数(OI)],血流动力学指标[心排血量(CO)、中心静脉压(CVP)、平均动脉压(MAP)]等临床资料。结果脱机时,2组患者机械通气指标均较治疗前降低,观察组低于对照组,观察组呼吸机使用时间短于对照组,差异有统计学意义(P<0.05)。治疗后,2组患者PaO_(2)、OI均较治疗前升高,观察组高于对照组,治疗后2组P(A-a)O_(2)较治疗前降低,观察组低于对照组,2组比较差异有统计学意义(P<0.05)。治疗后2组患者CO较治疗前升高,观察组高于对照组,治疗后2组CVP和MAP与治疗前相比差异无统计学意义,组间比较差异亦无统计学意义(P>0.05)。结论液体负平衡治疗重型颅脑损伤合并ARDS患者疗效满意,明显降低了机械通气指标,缩短了呼吸机使用时间,升高了PaO_(2),OI和CO,降低了P(A-a)O_(2),值得在临床上推广应用。Objective To investigate the effect of negative fluid balance therapy on mechanical ventila⁃tion,oxygenation status and hemodynamic indicators in patients with severe craniocerebral injury combined with ARDS.Methods A retrospective analysis of 83 patients with severe craniocerebral injury combined with ARDS treated in our department from October 2019 to December 2021 were used as the research subjects.Forty-one patients in the control group were given conventional treatment,and 42 cases in the observation group were given negative fluid balance treatment on the basis of conventional treatment.The clinical data,mechanical ventilation(inhaled oxygen concentration(FiO_(2)),plateau pressure(Pplat),positive end-expiratory pressure(PEEP),ventila⁃tor use time),oxygenation status(partial pressure of oxygen(PaO_(2)),alveolar-arterial oxygen differential pressure[P(A-a)O_(2)],oxygenation index(OI)),hemodynamic indicators(cardiac output(CO),central venous pressure(CVP),mean arterial pressure(MAP)),were compared between the two groups of patients before and after treat⁃ment.Results When weaned,the mechanical ventilation indexes of the two groups were lower than before treat⁃ment,the observation group was lower than the control group,and the observation group was used for a shorter period of time than the control group.The difference was statistically significant(P<0.05).After treatment,PaO_(2) and OI of the two groups of patients were higher than before treatment.The observation group was higher than the con⁃trol group.After treatment,the P(A-a)O_(2) of the two groups was lower than before treatment.The observation group was lower than the control group.There are statistics in comparison between the two groups.Academic signifi⁃cance(P<0.05).After treatment,the CO of the two groups of patients was higher than that before treatment,and the observation group was higher than that of the control group.After treatment,the CVP and MAP of the two groups were not statistically significant compared with before treatment,an

关 键 词：液体负平衡 重型颅脑损伤 急性呼吸窘迫综合征 机械通气 血流动力学 

分 类 号：R651.1[医药卫生—外科学]