肺复张干预联合高侧卧位对重症肺炎合并ARDS机械通气患者康复效果与并发症的影响  

Effects of lung recruitment intervention combined with high lateral position on the rehabilitation and complications of mechanically ventilated patients with severe pneumonia and acute respiratory distress syndrome

作　　者：刘茳 徐伟华[1] 刘杨 许翠娟 刘静 LIU Jiang;XU Weihua;LIU Yang(Department of Critical Care Medicine,the People’s Hospital of Langfang City,Hebei,Langfang 065000,China)

机构地区：[1]河北省廊坊市人民医院重症医学科,065000

出　　处：《河北医药》2024年第21期3272-3275,3279,共5页Hebei Medical Journal

基　　金：廊坊市科技支撑计划项目(编号:2023013061)。

摘　　要：目的探讨肺复张干预联合高侧卧位对重症肺炎合并急性呼吸窘迫综合征(ARDS)机械通气患者康复效果与并发症发生的影响。方法选择2021年12月至2023年12月接受机械通气治疗的重症肺炎合并ARDS患者70例,根据信封内置序号盲抽法均分成观察组(奇数者,n=35)和对照组(偶数者,n=35)。对照组予以高侧卧位机械通气,观察组在对照组基础上予以肺复张干预,比较2组患者的康复效果、机械通气相关指标、呼吸功能和并发症发生情况。结果观察组总住院时间、重症监护室(ICU)治疗时间和机械通气时间明显短于对照组,而脱机成功率高于对照组,差异有统计学意义(P<0.05)。观察组患者的氧合指数、静态肺顺应性(Cst)和动态肺顺应性(Cdyn)明显高于对照组,而浅快呼吸指数(RSBI)和气道峰压(PIP)水平低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为14.29%低于对照组的42.86%,差异有统计学意义(χ^(2)=7.000,P=0.008)。结论重症肺炎合并ARDS患者实施肺复张干预联合高侧卧位机械通气能够有效改善氧合功能,加速康复进程,提升呼吸功能和降低并发症的发生。Objective To explore the effects of lung recruitment intervention combined with high lateral position on the rehabilitation and complications of mechanically ventilated patients with severe pneumonia and acute respiratory distress syndrome(ARDS).Methods A total of 70 patients with severe pneumonia and ARDS who received mechanical ventilation from December 2021 to December 2023 were randomly divided into the observation group(odd numbered,n=35)and control group(even numbered,n=35)using blind sampling method based on the odd/even number in the envelope.High lateral lying mechanical ventilation was given in both groups,while patients in the observation group additionally received lung recruitment intervention.Rehabilitation effects,mechanical ventilation-related indicators,respiratory function and incidence of complications were compared between groups.Results Length of stay,length in intensive care unit(ICU)and mechanical ventilation time of the observation group were significantly shorter than those of the control group,while the success rate of weaning was significantly higher(P<0.05).The oxygenation index,lung static compliance(Cst)and lung dynamic compliance(Cdyn)of the observation group were significantly higher than those of the control group,while the rapid shallow breathing index(RSBI)and peak inflation pressure(PIP)levels were significantly lower(P<0.05).The incidence of complications in the observation group was significantly lower than that of the control group(14.29%,vs 42.86%,χ^(2)=7.000,P=0.008).Conclusion The implementation of lung recruitment intervention combined with high lateral position mechanical ventilation in patients with severe pneumonia and ARDS effectively improves oxygenation function,accelerates rehabilitation process,enhances respiratory function and reduces the incidence of complications.

关 键 词：重症肺炎 急性呼吸窘迫综合征 机械通气 高侧卧位 肺复张 

分 类 号：R563.1[医药卫生—呼吸系统]