摘要
目的对比俯卧位肺复张策略与压力控制肺复张策略对急性呼吸窘迫综合征(ARDS)患者动脉血气的影响。方法选择我院2011年12月—2013年12月收治的ARDS患者42例,采用随机数字表法将其分为A、B两组,每组21例。A组患者采用俯卧位肺复张策略,B组患者采用压力控制肺复张策略。观察两组患者复张前及复张后30 min、6 h、24 h桡动脉血气,预后及并发症情况。结果组内比较:A组、B组患者不同时间点pH值、PaO2、PaCO2、氧合指数(PaO2/FiO)比较,差异均有统计学意义(P<0.05)。组间比较:A组与B组患者复张前pH值、PaO2、PaCO2、PaO2/FiO比较,差异均无统计学意义(P<0.05);复张后30 min,B组患者pH值、PaO2、PaO2/FiO大于A组,PaCO2小于A组(P<0.05);复张后6 h和复张后24 h,A组患者PaO2、PaO2/FiO大于B组(P<0.05)。A组患者通气时间为(19.3±5.6)d,B组为(17.8±7.2)d,差异无统计学意义(P>0.05)。A组患者28 d病死率为33%(7/21),B组为29%(6/21),差异无统计学意义(P>0.05)。A组患者出现气管插管脱出1例,面部、胸部皮肤压伤3例,B组患者未出现气压伤及肺泡剪切伤相关并发症。结论俯卧位肺复张策略肺复张效果缓慢而温和,持续时间较长,压力控制肺复张策略肺复张效果迅速而强烈,持续时间较短,临床上应根据患者病情严重程度及耐受性灵活选择肺复张策略。
Objective To compare the effect of prone position lung recruitment and pressure control lung recruitment on arterial blood gases in patients with acute respiratory distress syndrome （ ARDS ）. Methods A total of 42 ARDS patients were selected in our hospital from December 2011 to December 2013,and they were randomly divided into groups A and B ac-cording to random number table,each of 21 cases. Group A given prone position lung recruitment,while goup B given pressure control lung recruitment. The arterial blood gas was detected before lung recruitment,30 min,6 h,24 h after lung recruitment, and prognosis and complications observed. Results Intra-group comparison showed that,there were significant differences in pH,PaO2,PaCO2,and PaO2/FiO of groups A and B（P﹤0. 05）. Inter-group comparison showed that,there was no signif-icant differences in pH,PaO2,PaCO2,and PaO2/FiO between the two groups before lung recruitment（P﹥0. 05）;30 min af-ter lung recruitment,pH,PaO2 ,PaO2/FiO of group B were significantly higher than those of group A,PaCO2 was lower（ P﹤0. 05）;6 h,24 h after lung recruitment,PaO2 ,PaO2/FiO of group A were significantly higher than those of group B（ P﹤0. 05）. During the 28 days of hospitalization,7 cases died（33%）in group A and 6 cases in group B（29%）,there was no significant differences between the two groups. In group A,1 case occurred fall off of trachea cannula,3 cases occurred pressure ulcer of face and chest skins,no one occurred complications in group B. Conclusion The effect of prone position lung recruit-ment is slow and gentle,lasting time is longer,while pressure control lung recruitment is quick and strong,lasting time is shor-ter. Flexible clinical options of lung recruitment should be make according to the patients＆#39;severity and tolerance.
出处
《实用心脑肺血管病杂志》
2014年第8期25-27,共3页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
呼吸窘迫综合征
成人
血气分析
肺不张
Respiratory distress syndrome,adult
Blood gas analysis
Atelectasis
