布地奈德雾化联合PCV肺复张方法对ARDS患者血流动力学氧合状态及炎症反应的影响  

Effects of Budesonide Nebulization Combined with PCV Lung Recruitment Maneuver on Hemodynamics Oxygenation Status and Inflammatory Response in Patients with ARDS

作　　者：刘秋玉 王思美 张丹 梁拯华 刘泽芳 许金龙 LIU Qiuyu;WANG Simei;ZHANG Dan(School of Medicine,University of Electronic Science and Technology of China/Mianyang Central Hospital,Sichuan Mianyang 621000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院/绵阳市中心医院重症医学科,四川绵阳621000

出　　处：《河北医学》2023年第5期834-839,共6页Hebei Medicine

基　　金：四川省基层卫生事业发展研究中心2020年立项项目,(编号:SWFZ20-Y-015)。

摘　　要：目的:观察布地奈德雾化联合压力控制(PCV)肺复张方法对急性呼吸窘迫综合征(ARDS)患者血流动力学、氧合状态及炎症反应的影响。方法:选取我院2019年2月至2022年5月收治的ARDS患者103例,采用简单随机化法分为对照组51例和观察组52例。两组均采用PCV肺复张方法干预,观察组给予布地奈德雾化治疗,对照组给予0.9%氯化钠溶液雾化治疗。比较两组氧合状态、血流动力学及炎症反应的水平,记录两组机械通气时间、ICU住院时间及病死率。结果:治疗前,两组氧合状态相关指标及血流动力学比较,差异无统计学意义(P>0.05);两组治疗后动脉氧分压(PaO_(2))、氧合指数(PaO_(2)/FiO_(2))及中心静脉压(CVP)均较治疗前显著升高,平均动脉压(MAP)和心率(HR)均较治疗前显著下降,组间比较提示观察组治疗后氧合状态指标较对照组更高,差异有统计学意义(P<0.05),观察组治疗后血流动力学与对照组比较,差异无统计学意义(P>0.05);观察组治疗前后氧合状态指标、MAP、CVP差值较对照组更大,差异有统计学意义(P<0.05),HR治疗前后差值与对照组比较,差异无统计学意义(P>0.05)。治疗前,两组炎症反应比较,差异无统计学意义(P>0.05);两组治疗后中性粒细胞数-淋巴细胞数比值(NLR)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、降钙素原(PCT)均较治疗前显著下降,组间比较提示观察组治疗后较对照组更低,同时治疗前后差值较对照组更大(P<0.05)。观察组机械通气时间、ICU住院时间短于对照组,病死率与对照组比较,差异无统计学意义(P>0.05)。结论:布地奈德雾化联合PCV肺复张方法治疗ARDS可改善患者血流动力学和氧合状态,减轻炎症反应,促进患者康复。Objective:To observe the effect of budesonide nebulization combined with pressure controlled ventilation(PCV)lung recruitment method on hemodynamics,oxygenation status and inflammatory response in patients with acute respiratory distress syndrome(ARDS).Methods:A total of 103 patients with ARDS admitted in our hospital from February 2019 to May 2022 were selected and divided into control group(51 cases)and observation group(52 cases)by simple randomization method.Both groups were intervened with PCV lung recruitment maneuver.The observation group was given budesonide nebulization treatment,and the control group was given 0.9% sodium chloride solution nebulization treatment.The oxygenation status,hemodynamics and inflammatory reaction levels were compared between the two groups,and the duration of mechanical ventilation,length of stay in ICU and mortality were recorded.Results:Before treatment,there were no significant statistical differences in oxygenation-related indexes and hemodynamics between the two groups(P>0.05).After treatment,the arterial oxygen partial pressure(PaO_(2)),oxygenation index(PaO_(2)/FiO_(2))and central venous pressure(CVP)in both groups were significantly higher than before treatment,while the mean arterial pressure(MAP)and heart rate(HR)were significantly lower than before treatment.The comparison between groups suggested that the oxygenation status index in the observation group was higher than that in the control group after treatment.The difference was statistically significant(P<0.05),while there was no significant statistical difference in hemodynamics between the observation group and the control group after treatment(P>0.05).The differences of oxygenation status index,MAP and CVP in the observation group before and after treatment were greater than that in the control group,and the difference was statistically significant(P<0.05),while the difference of HR before and after treatment was not statistically significant(P>0.05).Before treatment,there was no significant statistical differ

关 键 词：布地奈德 压力控制 肺复张 急性呼吸窘迫综合征 氧合状态 

分 类 号：R563.8[医药卫生—呼吸系统]