摘要
目的探究早期气道压力释放通气(APRV)模式下自主呼吸强度评价对中重度急性呼吸窘迫综合征(ARDS)患者氧合、肺顺应性及预后的影响。方法选取2021年1月—2023年1月成都市双流区第一人民医院60例中重度ARDS患者,按照1∶1比例随机分为研究组(30例)、对照组(30例),开展前瞻性研究。两组初始均给予容量控制通气1 h后转为APRV模式,给予镇静/镇痛处置,研究组每小时监测气道吸气闭合压(P0.1),对照组每小时监测自发每分通气量/每分总通气量(MVspont/MV)。比较两组治疗前(T0)和治疗1 h后(T_(1))、6 h后(T_(2))、12 h后(T_(3))、24 h后(T_(4))、48 h后(T_(5))、72 h后(T_(6))氧合指标[动脉二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、酸碱度(pH值)、血乳酸(Lac)]、肺顺应性(动态顺应性、静态顺应性)、呼吸力学参数[气道峰压(Ppeak)、气道平台压(Pplat)]、血流动力学指标[心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)],并比较两组预后情况。结果研究组T0~T_(6)时刻PaCO_(2)、pH值与对照组比较,差异无统计学意义(P>0.05),T_(1)~T_(6)时刻PaO_(2)高于对照组,Lac低于对照组(P<0.05);研究组T_(1)~T_(6)时刻动态顺应性、静态顺应性高于对照组(P<0.05),Ppeak、Pplat低于对照组(P<0.05);研究组T0~T_(6)时刻HR与对照组比较,差异无统计学意义(P>0.05),研究组T_(1)~T_(6)时刻MAP高于对照组,CVP低于对照组(P<0.05);研究组机械通气时间、ICU治疗时间、住院时间短于对照组,28 d全因病死率(6.67%)低于对照组(26.67%)(P<0.05),但研究组拔管成功率(90.00%)与对照组(80.00%)比较,差异无统计学意义(P>0.05)。结论P0.1作为早期APRV模式下监测自主呼吸强度的指标,有助于改善患者肺顺应性,恢复血流动力学与呼吸力学,改善患者氧合状态,进而降低患者28 d全因病死率,促进患者早日康复。
Objective To investigate the effects of early airway pressure release ventilation(APRV)mode of spontaneous breathing intensity evaluation on oxygenation,lung compliance and prognosis in patients with moderate to severe acute respiratory distress syndrome(ARDS).Methods Sixty patients with moderate-to-severe ARDS in our hospital from January 2021 to January 2023 were selected and randomly divided into a study group(30 patients)and a control group(30 patients)according to a 1∶1 ratio for a prospective study.Both groups were initially given volumecontrolled ventilation for 1 h and then switched to APRV mode with sedation/analgesia management.Airway inspiratory closure pressure was monitored hourly in the study group(P0.1)and spontaneous minute ventilation/total ventilation per minute(MVspont/MV)was monitored hourly in the control group.The two groups were compared before treatment(T0),after 1-hour of treatment(T_(1)),after 6-hour(T_(2)),after 12-hour(T_(3)),after 24-hour(T_(4)),after 48-hour(T_(5))and after 72 hour(T_(6))for oxygenation parameters[arterial partial pressure of carbon dioxide(PaCO_(2)),arterial partial pressure of oxygen(PaO_(2)),acidity(pH),blood lactate(Lac)],lung compliance(dynamic compliance,Static compliance),respiratory mechanics parameters[peak airway pressure(Ppeak),plateau airway pressure(Pplat)],haemodynamic parameters[heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP)],and to compare adverse events and prognosis between the two groups.Results There was no significant difference in PaCO_(2)and pH values between the study group and the control group at T0-T_(6)hours(P>0.05).PaO_(2)was higher than that of the control group at T_(1)-T_(6)hours,Lac was lower than that of the control group(P<0.05).The dynamic compliance and static compliance of the study group at T_(1)-T_(6)were higher than those of the control group(P<0.05).Ppeak and Pplat in the study group were lower than those in the control group from T_(1)-T_(6)(P<0.05).There was no significant difference in HR between
作者
李暾
沈金蓉
LI Tun;SHEN Jinrong(Department of Intensive Care Medicine,Chengdu Shuangliu District First People's Hospital,Chengdu Sichuan 610200,China)
出处
《中国急救复苏与灾害医学杂志》
2023年第11期1452-1458,共7页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
2020年四川省医学科研项目(编号:S20041)。
