气道压力释放通气与小潮气量保护性通气策略对急性呼吸窘迫综合征的疗效对比研究  

Comparative study on therapeutic effects of airway pressure release ventilation and low tidal volume protective ventilation strategy on acute respiratory distress syndrome

作　　者：刘金星 刘先发 LIU Jinxing;LIU Xianfa(Emergency Department of the First Clinical Medical College of Gannan Medical University,Ganzhou City,Jiangxi Province,341000;Emergency Department of the First Affiliated Hospital of Gannan Medical University,Ganzhou City,Jiangxi Province,341000,China)

机构地区：[1]赣南医科大学第一临床医学院急诊科,江西赣州341000 [2]赣南医科大学第一附属医院急诊科,江西赣州341000

出　　处：《蛇志》2024年第3期297-302,共6页Journal of Snake

摘　　要：目的比较气道压力释放通气(APRV)与小潮气量保护性通气策略(LTV)对急性呼吸窘迫综合征(ARDS)的疗效。方法回顾性分析200例中重度ARDS患者的临床资料,根据患者的治疗方式不同分为APRV组(n=103)和LTV组(n=97)。比较两组患者的血气指标、急性生理及慢性健康评分标准II(APACHE II)评分和Murray急性肺损伤(mlIS)评分、炎症因子、循环功能、疾病转归情况。结果治疗72 h后,两组患者的氧分压(PaO_(2))、血氧饱和度(SpO_(2))、氧合指数(OI)水平均升高,二氧化碳分压(PaCO_(2))水平下降,且APRV组患者的PaO_(2)、SpO_(2)、OI水平高于LTV组,PaCO_(2)水平低于LTV组,差异均有统计学意义(均P<0.05)。治疗72 h后,两组患者的APACHE II评分及mlIS评分均下降,且APRV组的APACHE II评分及mlIS评分均较LTV组降低,差异均有统计学意义(均P<0.05)。治疗72 h后,两组患者的白细胞介素-6(IL-6)、降钙素(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)均下降,且APRV组的IL-6、PCT、CRP、WBC均较LTV组降低,差异均有统计学意义(均P<0.05)。治疗72 h后,两组患者的静脉压(CVP)、心率(HR)均有下降,心排血量(CO)、平均动脉压(MAP)水平均有上升,且APRV组的CVP、HR均较LTV组低,CO、MAP均较LTV组高,差异均有统计学意义(均P<0.05)。两组患者的疾病转归情况比较,APRV组患者使用呼吸机时间、住重症加强护理病房(ICU)时间均较LTV组短,死亡率较LTV组降低,差异均有统计学意义(均P<0.05);而两组患者的并发症比较差异无统计学意义(P>0.05)。结论APRV用于ARDS的治疗效果优于LTV,能有效改善ARDS患者的血气功能、炎症反应、循环功能和肺功能,缩短使用呼吸机时间,降低ARDS患者的死亡率,且不增加并发症发生率。Objective To compare the therapeutic effects of airway pressure release ventilation(APRV)and low tidal volume(LTV)protective ventilation strategy on acute respiratory distress syndrome(ARDS).Methods A retrospective analysis was performed on the clinical data of 200 patients with moderate to severe ARDS.Patients receiving APRV and LTV protective ventilation strategy were included in APRV group(n=97)and LTV group(n=103).The two groups were compared on blood gas indicators,the Acute Physiology and Chronic Health Evaluation(APACHE)II score,the Murray lung injury score(MLIS),inflammatory factors,circulatory function,and outcome of the disease.Results After 72 h of treatment,there were increases in partial pressure of oxygen(PaO_(2)),blood oxygen saturation(SpO_(2))and oxygenation index(OI),and decrease in partial pressure of carbon dioxide(PaCO_(2))in both groups.Meanwhile,PaO_(2),SpO_(2)and OI in APRV group were higher than those in LTV group,and PaCO_(2)was lower than that in LTV group(all P<0.05).After 72 h of treatment,APACHE II scores and MLIS scores of both groups decreased,and APRV group had lower scores than LTV group(all P<0.05).After 72 h of treatment,the levels of interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)and white blood cell count(WBC)in both groups decreased,and the levels in APRV group were lower than those in LTV group(all P<0.05).After 72 h of treatment,there were decreases in central venous pressure(CVP)and heart rate(HR),and increases in cardiac output(CO)and mean arterial pressure(MAP)in both groups.Meanwhile,CVP and HR of APRV group were lower than those of LTV group.CO and MAP were higher than those of LTV group(all P<0.05).The time to weaning and length of ICU stay in APRV group were shorter,and mortality rate was lower compared to LTV group(all P<0.05).The incidence rates of complications in the two groups were close(P>0.05).Conclusion Compared with LTV,APRV can better improve blood gas,inflammatory response,circulatory function and pulmonary function in patients with ARDS.In

关 键 词：急性呼吸窘迫综合征 气道压力释放通气 小潮气量保护性通气策略 

分 类 号：R563[医药卫生—呼吸系统]