不同潮气量机械通气联合氨溴索对ARDS患者肺损伤及炎性反应的抑制作用探讨  

Inhibitory effect of mechanical ventilation with different tidal volume combined with Ambroxol on lung injury and inflammatory response in patients with ARDS

作　　者：王建国 Wang Jianguo(The People's Hospital of County,Nancheng,Jiangxi 344700)

机构地区：[1]南城县人民医院,江西南城344700

出　　处：《基层医学论坛》2023年第17期11-13,17,共4页The Medical Forum

摘　　要：目的探讨急性呼吸窘迫综合征(ARDS)患者应用不同潮气量机械通气+氨溴索治疗对肺损伤以及炎性反应的抑制作用。方法选取2018年9月—2021年9月南城县人民医院收治的60例ARDS患者为研究对象,均应用机械通气联合氨溴索治疗,根据患者机械通气使用潮气量的不同分成传统潮气量组(n=30)与小潮气量组(n=30),对2组通气前与通气24 h的血气指标、肺损伤及炎性反应指标变化,病死率与感染率进行对比。结果血气指标上,2组患者通气24 h的动脉血氧分压(PaO_(2))与动脉血pH值较通气前提高,动脉血二氧化碳分压(PaCO_(2))较通气前降低,且传统潮气量组指标变化幅度比小潮气量组更显著(P<0.05);肺损伤与血清炎性因子指标上,治疗后2组患者肺损伤指标唾液酸化大分子黏蛋白(KL-6)与肺表面活性蛋白D(SP-D)、血清降钙素原(PCT)、可溶性血栓调节蛋白(sTM)与肿瘤坏死因子-α(TNF-α)水平较治疗前降低,且传统潮气量组明显低于小潮气量组(P<0.05);传统潮气量组病死率与感染率分别为0,6.67%,小潮气量组分别为3.33%,10.00%,差异无统计学意义(P>0.05)。结论对ARDS患者应用传统潮气量机械通气联合氨溴索的效果满意,可显著改善动脉血气指标,减轻肺损伤及抑制炎症反应。Objective To explore the treatment of acute respiratory distress syndrome(ARDS)patients were treated with different tidal volume mechanical ventilation+ambroxol to inhibit lung injury and inflammatory response.Methods 60 ARDS patients treated from September 2018 to September 2021 were treated with mechanical ventilation combined with ambroxol.According to the tidal volume used by mechanical ventilation,the patients were divided into traditional tidal volume group(n=30)and low tidal volume group(n=30),the changes of blood gas indexes,lung injury and inflammatory response indexes in each group before ventilation and 24 hours after ventilation were observed,and the mortality and infection rate in each group were compared.Results In terms of blood gas indexes,the arterial oxygen partial pressure(PaO_(2))and arterial pH value in 24 hours after ventilation were higher than those before ventilation,and the arterial carbon dioxide partial pressure(PaCO_(2))was lower than that before ventilation,and the change range of indexes in the traditional tidal volume group was significantly higher than that in the low tidal volume group(P<0.05);in terms of lung injury and serum inflammatory factors,after treatment,patients in each group had the following indexes:sialylated macromolecular mucin(KL-6),lung surfactant protein D(SP-D),serum procalcitonin(PCT)and soluble thrombomodulin(STM)and tumor necrosis factor-α(TNF-α)The level was lower than that before treatment,The 24-hour indexes in the traditional tidal volume group were significantly lower than those in the low tidal volume group(P<0.05);the mortality and infection rates in the traditional tidal volume group were 0 and 6.67%respectively,and those in the low tidal volume group were 3.33%and 10.00%respectively.There was no significant difference between the two groups.Conclusion The effect of traditional tidal volume mechanical ventilation combined with ambroxol in patients with ARDS is satisfactory,which can significantly improve the arterial blood gas index,reduce lung inj

关 键 词：急性呼吸窘迫综合征 肺损伤 机械通气 不同潮气量 氨溴索 炎性反应 

分 类 号：R563.9[医药卫生—呼吸系统]