摘要
目的:探讨无创呼吸机呼吸末正压通气(PEEP)参数设置在重症急性胰腺炎(SAP)患者俯卧位机械通气中的应用。方法:选取泉州市第一医院120例SAP患者,根据随机数字表法分为两组,各60例。两组均行无创呼吸机俯卧位机械通气,观察组为PEEP≥10 cm H_(2)O,对照组为PEEP≤5 cm H_(2)O,比较两组并发症发生率、病死率、机械通气、入住ICU及住院时间、治疗前及治疗后72 h每分钟通气量、动脉血氧分压(PaO_(2))、心率(HR)、呼吸频率、动脉血二氧化碳分压(PaCO_(2))、气道闭合压及气道峰值、pH值、平均动脉压(MAP)、CT严重程度指数(CTSI)、急性生理与慢性健康状况评分系统Ⅱ(APACHE-Ⅱ)评分。结果:观察组每分钟通气量、呼吸频率、PaO_(2)高于对照组,气道闭合压、气道峰值、PaCO_(2)、CTSI评分、APACHE-Ⅱ评分低于对照组(P<0.05);两组治疗前后MAP、HR比较,差异无统计学意义(P>0.05);观察组机械通气、入住ICU及住院时间均短于对照组(P<0.05);观察组出院90 d病死率低于对照组(P<0.05)。结论:无创呼吸机俯卧位机械通气期间PEEP≥10 cm H_(2)O治疗SAP患者,可有效改善肺内氧合,有助于缩短治疗及康复时间,改善患者预后。
Objective To investigate the effect of non-invasive positive end-expiratory pressure(PEEP)on prone position mechanical ventilation in patients with severe acute pancreatitis(SAP).Methods A total of 120 SAP patients in Quanzhou First Hospital were enrolled.The patients were mechanically ventilated using non-invasive ventilator in prone position,with PEEP≥10 cmH_(2)O in observation group(n=60)and PEEP≤5 cmH_(2)O in control group(n=60).The two groups were compared in terms of incidence of complications,mortality rate,mechanical ventilation,ICU stay and hospital stay,ventilation per minute before and at 72 h after treatment,arterial partial pressure of oxygen(PaO_(2)),heart rate(HR),respiratory rate,arterial partial pressure of carbon dioxide(PaCO_(2)),airway closure pressure and peak airway pressure,pH,mean arterial pressure(MAP),CT severity index(CTSI),and acute physiology and chronic health evaluation scoring system II(APACHE-II)score.Results Compared with control group,observation group had higher ventilation per minute,respiratory rate and PaO_(2),and lower airway closure pressure,peak airway pressure,PaCO_(2),CTSI score and APACHE-II score(P<0.05).There was no statistically significant difference in MAP and HR between two groups before and after treatment(P>0.05).Mechanical ventilation,ICU stay,and hospital stay in observation group were shorter than those of control group(P<0.05).The 90-d mortality rate was lower in observation group than in control group(P<0.05).Conclusion Non-invasive prone position mechanical ventilation with PEEP≥10 cmH_(2)O for SAP effectively improves intrapulmonary oxygenation,contributes to a shorter treatment and rehabilitation,and improves patient prognosis.
作者
叶梅真
吴碧瑜
刘春芳
邱燕燕
李颖怡
YE Meizhen;WU Biyu;LIU Chunfang;QIU Yanyan;LI Yingyi(Department of Gastroenterology,Quanzhou First Hospital(Quanzhou First Hospital Affiliated to Fujian Medical University),Quanzhou 362000,China;Department of Nursing,Quanzhou First Hospital(Quanzhou First Hospital Affiliated to Fujian Medical University),Quanzhou 362000,China;Department of Infectious Diseases,Quanzhou First Hospital(Quanzhou First Hospital Affiliated to Fujian Medical University),Quanzhou 362000,China)
出处
《中国医学物理学杂志》
CSCD
2023年第11期1418-1422,共5页
Chinese Journal of Medical Physics
基金
福建省自然科学基金(2020J011282)。
关键词
重症急性胰腺炎
机械通气
无创呼吸机
呼吸末正压通气
俯卧位
severe acute pancreatitis
mechanical ventilation
non-invasive ventilator
positive end-expiratory pressure
prone position
