摘要
目的:观察中重度急性呼吸窘迫综合征(ARDS)患者应用俯卧位通气联合气道压力释放通气(APRV)呼吸模式治疗的疗效。方法:2018年12月—2021年3月河南科技大学附属黄河医院ICU收治应用有创通气呼吸机的ARDS患者86例,其中56例中重度患者需行俯卧位通气,根据涂层刮卡法将此类患者随机分为俯卧位通气联合APRV模式组(观察组)和俯卧位通气联合常规通气组(对照组),每组28例,记录2组患者入ICU后通气治疗前以及治疗后12 h、24 h、48 h、72 h的呼吸参数、血流动力学参数并统计预后情况,绘制Kaplan-Meier生存曲线,比较2组患者的主要结局(30 d生存时间)和次要结局(ICU住院时间)。结果:观察组72 h内氧合指标(SaO_(2)、PaO_(2)、PaO_(2)/FiO_(2))较对照组明显升高,无效腔分数(VD/VT)指标较对照组下降,差异有统计学意义(P<0.01),观察组72 h内血流动力学指标(MAP、CVP)较对照组明显好转,差异有统计学意义(P<0.001),观察组与对照组患者临床预后情况比较,差异有统计学意义[机械通气时间:(8.9±3.6) d vs.(12.6±3.2) d、拔管成功率:82.1%vs.53.6%、气胸发生率:7.1%vs.28.6%、谵妄发生率:14.3%vs.42.9%、30 d住院病死率:17.9%vs.46.4%,均P<0.05]。Kaplan-Meier生存曲线结果显示:观察组生存情况优于对照组患者(logRank检验χ2=5.026,P=0.023),观察组ICU住院时间显著短于对照组患者[中位时间13 d(95%CI:6.8~24.8) vs.20 d(95%CI:10.4~38.2),χ2=8.830,P=0.003]。结论:早期(72 h)俯卧位通气患者应用APRV模式可显著改善中重度ARDS患者的呼吸参数、血流动力学指标,有较少的气胸和谵妄发生率,脱机时间短,拔管成功率高,可改善生存预后。
Objective: To observe the efficacy of prone position ventilation combined with airway pressure release ventilation(APRV) in patients with moderate to severe acute respiratory distress syndrome(ARDS). Methods: Eighty-six ARDS patients were admitted to the Yellow River Hospital Affiliated to Henan University of Science and Technology from December 2018 to March 2021. Fifty-six of them need prone ventilation. According to the coating scratch card method, they were were randomly divided into prone ventilation combined with APRV mode group(observation group) and prone ventilation combined with conventional ventilation group(control group), with 28 patients in each group. Respiratory parameters and hemodynamic parameters before and 12 h, 24 h, 48 h, 72 h after ICU ventilation treatment in the two groups were recorded, and prognosis of the two groups was counted. Draw a Kaplan-Meier survival curve, and compare the primary outcome(30 d survival time) and secondary outcome(ICU hospital stay) of the two groups. Results: The oxygenation index(SaO_(2), PaO_(2), PaO_(2)/FiO_(2)) of the observation group within 72 hours was significantly higher than that of the control group, and the void fraction(VD/VT) index was lower than that of the control group, and the difference was statistically significant(P<0.01);The hemodynamic indicators(MAP, CVP) within 72 hours were significantly better than those in the control group, and the differences were statistically significant(P<0.001);the clinical prognosis of the two groups was statistically significant[mechanical ventilation time(d): 8.9±3.6 vs. 12.6±3.2, success rate of extubation(%): 82.1 vs. 53.6, incidence of pneumothorax(%): 7.1 vs. 28.6, incidence of delirium(%): 14.3 vs. 42.9, 30 d hospital mortality rate(%): 17.9 vs. 46.4, all P<0.05]. Kaplan-Meier survival curve results showed that the survival of ARDS patients in the observation group was significantly better than those in the control group(logRank testχ2=5.026, P=0.023), and the ICU hospitalization time of ARDS patients
作者
兀瑞俭
詹晓娟
郭发瑞
柴晓波
WU Ruijian;ZHAN Xiaojuan;GUO Farui;CHAI Xiaobo(Department of Critical Care Medicine,Yellow River Hospital Affiliated to Henan University of Science and Technology,Sanmenxia,Henan,472000,China)
出处
《临床急诊杂志》
CAS
2021年第10期667-672,共6页
Journal of Clinical Emergency
关键词
俯卧位通气
急性呼吸窘迫综合征
气道压力释放通气模式
治疗效果
prone position ventilation
acute respiratory distress syndrome
airway pressure release ventilation mode
therapeutic effect
