以P0.1为指导的镇痛镇静对减少重度急性呼吸窘迫综合征患者肺损伤的研究  

Study on analgesia and sedation guided by P0.1 to reduce lung injury of patients with severe acute respiratory distress syndrome

作　　者：王伟钟 刘伟董 章攀 沈波 WANG Weizhong;LIU Weidong;ZHANG Pan;SHEN Bo(Department of General Intensive Care Unit,Shaoxing People's Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院重症医学科,312000

出　　处：《浙江医学》2024年第2期182-186,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2021KY365)。

摘　　要：目的探讨以气道闭合压(P0.1)为指导的镇痛镇静与减少重度急性呼吸窘迫综合征(ARDS)患者肺损伤的关系,指导重度ARDS患者机械通气。方法选取2021年10月至2023年6月在绍兴市人民医院ICU接受机械通气治疗的重度ARDS患者70例为研究对象,采用随机数字表法将患者分为实验组和对照组,各35例。机械通气48 h内两组均深度镇痛镇静以消除自主呼吸。机械通气49~168 h,对照组以Richmond躁动-镇静量表(RASS)评分维持在-2~0分为目标实施镇痛镇静;实验组以P0.1作为呼吸努力强弱的量化指标,维持在1~3.5 cmH_(2)O(1 cmH_(2)O=0.098 kPa),用以指导患者实施镇痛镇静。采用ELISA法检测两组患者机械通气第48、120、168小时的血清肺表面活性蛋白D(SP-D)、涎液化糖链抗原(KL-6)水平。同时观察两组患者第48、120、168小时P0.1、氧合指数,比较两组患者死亡率。结果实验组患者机械通气第120小时[(102.73±19.25)ng/mL比(113.57±21.19)ng/mL]、第168小时[(91.28±27.47)ng/mL比(106.35±28.47)ng/mL]血清SP-D水平均低于对照组,差异均有统计学意义(均P<0.05)。两组患者第48小时血清SP-D水平及第48、120、168小时血清KL-6水平比较差异均无统计学意义(均P>0.05)。实验组患者机械通气第48小时[(1.83±0.52)cmH_(2)O比(4.05±0.62)cmH_(2)O]、第120小时[(2.28±0.46)cmH_(2)O比(4.31±0.72)cmH_(2)O]、第168小时[(2.94±0.48)cmH_(2)O比(4.23±1.06)cmH_(2)O]P0.1均低于对照组,差异均有统计学意义(均P<0.01)。两组患者第48、120、168小时氧合指数比较差异均无统计学意义(均P>0.05)。两组患者死亡率比较差异无统计学意义(P=0.597)。结论以P0.1为指导的镇痛镇静,可以降低重度ARDS患者血清肺损伤标志物SP-D值,有助于减少重度ARDS患者肺损伤。Objective To explore the relationship between analgesia and sedation guided by P0.1 and the reduction lung injury in patients with severe acute respiratory distress syndrome(ARDS),and to guide mechanical ventilation for patients with severe ARDS.Methods A total of 70 patients with severe ARDS who received mechanical ventilation in ICU of Shaoxing people's Hospital from October 2021 to June 2023 were randomly divided into control group and experimental group,each with 35 cases.Within 48 hours of mechanical ventilation,both groups received deep analgesia and sedation to eliminate spontaneous breathing.During the 49-168 h of mechanical ventilation,the control group received analgesia and sedation treatment to maintain Richmond Agitation-Sedation Scale(RASS)scores of-2-0,while in the experimental group,P0.1 was used as the quantitative index of respiratory effort,which was maintained at 1-3.5 cmH_(2)O(1 cmH_(2)O=0.098 kPa)to guide analgesia and sedation.The venous blood of patients in the two groups were taken at 48,120 and 168 h after mechanical ventilation,and the levels of pulmonary surfactant protein D(SP-D)and serum krebs von den lungen-6(KL-6)were detected by ELISA.P0.1 and oxygenation index values of patients in the two groups were observed at 48,120,and 168 hours,and the mortality of patients in the two groups was compared.Results The serum SP-D levels of the experimental group were lower than those of the control group at 120 hours[(102.73±19.25)ng/mL vs.(113.57±21.19)ng/mL]and 168 hours[(91.28±27.47)ng/mL vs.(106.35±28.47)ng/mL]of mechanical ventilation,and the differences were statistically significant(both P<0.05).There was no significant difference in the basic levels of SP-D(at 48 h)and KL-6(at 48,120 and 168 h)between the two groups(all P>0.05).The P0.1 of the experimental group was lower than that of the control group at 48 hours[(1.83±0.52)cmH_(2)O vs.(4.05±0.62)cmH_(2)O],120 hours[(2.28±0.46)cmH_(2)O vs.(4.31±0.72)cmH_(2)O],and 168 hours[(2.94±0.48)cmH_(2)O vs.(4.23±1.06)cmH_(2)O]of mechan

关 键 词：气道闭合压 急性呼吸窘迫综合征 镇痛 镇静 肺损伤 

分 类 号：R614[医药卫生—麻醉学]