摘要
目的探讨液体负平衡对腹部外伤伴急性呼吸窘迫综合征(ARDS)患者血流动力学指标、炎症因子浓度的影响。方法82例腹部外伤伴ARDS患者,采用电脑随机分组法分成对照组及观察组,各41例。对照组采用常规治疗,观察组在常规治疗的基础上采用液体负平衡治疗。比较两组患者的血流动力学指标[心排血量(CO)、心脏指数(CI)、血管外肺水指数(EVLWI)]、炎症因子[白介素-6(IL-6)]浓度、氧合情况{氧分压(PaO2)、肺泡-动脉氧分压差[P(A-a)O2]}、机械通气情况[吸入氧浓度(FiO2)、平台压(Pplat)、呼气末正压(PEEP)]、呼吸机使用时间。结果治疗后,观察组患者的CO(4.07±0.68)L/min、CI(4.78±0.42)L/(min·m^2)与对照组的(3.98±0.65)L/min、(4.75±0.43)L/(min·m^2)比较,差异均无统计学意义(P>0.05);治疗后观察组的EVLWI(5.37±0.29)ml/kg低于对照组的(6.91±0.36)ml/kg,差异具有统计学意义(P<0.05)。治疗后,观察组患者的PaO2(102.74±5.85)mm Hg(1 mm Hg=0.133 kPa)高于对照组的(87.57±5.36)mm Hg,P(A-a)O2(7.35±3.51)mm Hg、IL-6(147.05±10.62)pg/ml低于对照组的(15.24±3.68)mm Hg、(194.83±12.59)pg/ml,差异均具有统计学意义(P<0.05)。脱机时,观察组的PEEP(5.08±0.47)mm Hg、FiO2(40.28±1.69)%、Pplat(11.24±1.48)mm Hg低于对照组的(8.97±1.83)mm Hg、(50.83±1.27)%、(17.93±1.95)mm Hg,差异均具有统计学意义(P<0.05)。观察组患者的呼吸机使用时间为(4.62±0.37)d,短于对照组的(6.29±0.68)d,差异具有统计学意义(P<0.05)。结论腹部外伤伴ARDS治疗中维持液体负平衡可有效减轻肺部水肿症状,改善肺部感染、氧合情况,保护肺功能,降低呼吸机支持强度,缩短呼吸机使用时间,值得推广。
Objective To discuss the effect of negative fluid balance on hemodynamic indexes and inflammatory factor concentration in patients with abdominal trauma and acute respiratory distress syndrome(ARDS).Methods A total of 82 patients with abdominal trauma and ARDS were divided into control group and observation group according to computer random grouping,with 41 cases in each group.The control group received conventional therapy,and the observation group received negative fluid balance based on the conventional therapy.The hemodynamic indexes[cardiac output(CO),cardiac index(CI),extravascular lung water index(EVLWI)],inflammatory factor[interleukin-6(IL-6)]concentration,oxygenation situation{partial pressure of oxygen(PaO2),alveolar-arterial oxygen partial pressure difference[P(A-a)O2]},mechanical ventilation conditions[fraction of inhaled oxygen(FiO2),plateau pressure(Pplat),positive end expiratory pressure(PEEP)],ventilator use time were compared between the two groups.Results After treatment,CO(4.07±0.68)L/min and CI(4.78±0.42)L/(min·m^2)of the observation group had no statistically significant difference compared with(3.98±0.65)L/min and(4.75±0.43)L/(min·m^2)of the control group(P>0.05).After treatment,EVLWI(5.37±0.29)ml/kg of the observation group was lower than(6.91±0.36)ml/kg of the control group,and the difference was statistically significant(P<0.05).After treatment,PaO2(102.74±5.85)mm Hg(1 mm Hg=0.133 kPa)of the observation group was higher than(87.57±5.36)mm Hg of the control group,and P(A-a)O2(7.35±3.51)mm Hg and IL-6(147.05±10.62)pg/ml were lower than(15.24±3.68)mm Hg and(194.83±12.59)pg/ml of the control group,and the difference was statistically significant(P<0.05).When offline,the PEEP(5.08±0.47)mm Hg,FiO2(40.28±1.69)%,and Pplat(11.24±1.48)mm Hg of the observation group were lower than(8.97±1.83)mm Hg and(50.83±1.27)%,(17.93±1.95)mm Hg of the control group,and the difference was statistically significant(P<0.05).The ventilator use time of the observation group was(4.62±0.37)d,whic
作者
马克东
MA Ke-dong(Department of Surgery,Shenyang Emergency Center,Shenyang 110006,China)
出处
《中国现代药物应用》
2021年第1期4-7,共4页
Chinese Journal of Modern Drug Application
关键词
液体负平衡
腹部外伤
急性呼吸窘迫综合征
血流动力学
Negative fluid balance
Abdominal trauma
Acute respiratory distress syndrome
Hemodynamics
