摘要
目的探索循环保护通气4P标准策略对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)机械通气患者预后及结局的影响及潜在作用。方法回顾性纳入2021年3月—2022年6月入住中国医学科学院北京协和医院重症医学科行机械通气且符合循环保护通气4P标准策略的ARDS患者37例,并根据年龄、性别1∶1配对非4P患者37例。循环保护通气4P标准策略包括中心静脉压(central venous pressure,CVP)<10 mmHg,外周灌注指数(peripheral perfusion index,PI)>0.6,平均气道压(meas pressure of airway,Pmean)≤10 cmH_(2)O,脉压变异度(puls pressure variation,PPV)≤12%。主要结局指标为ICU死亡率、住ICU小时数、机械通气时间、28 d未使用机械通气天数。结果4P组无死亡,非4P组死亡率为2.70%(1例),差异无统计学意义(P>0.05)。4P组ICU监护小时数[150.00(123.50,203.00)h vs.205.00(148.50,306.50)h,P=0.017]、机械通气小时数[84.00(57.50,121.00)h vs.105.00(74.50,170.50)h,P=0.004]均短于非4P组,差异有统计学意义(P<0.05)。4P组28 d未使用机械通气天数长于非4P组[24.50(22.96,25.60)d vs.23.63(20.90,24.90)d],差异有统计学意义(P=0.004)。累积分数曲线示监护结束4P组28 d未进行机械通气天数显著延长,与非4P组比较,差异有统计学意义(P=0.018)。2组的生存分析曲线比较,差异无统计学意义(P=0.433)。结论循环保护通气4P标准策略可以减少重症患者机械通气时间,临床上使用该标准可以快速改善ARDS患者的预后,相关结果尚需多中心临床研究证实。
Objective To explore the impact and potential role of the 4P strategy of circulatory protection on the prognosis and outcome of mechanically ventilated patients with ARDS.Methods Thirty-seven ARDS patients admitted to the department of critical care medicine of Peking Union Medical College Hospital,Chinese Academy of Medical Sciences from March 2021 to June 2022 who were mechanically ventilated and adhered to the 4P strategy of circulatory protection ventilation were retrospectively included,and 37 patients in the non-4P group were paired 1∶1 according to age,sex.The 4P strategy consisted of CVP<10 mmHg,PI>0.6,Pmean≤10 cmH_(2)O,and PPV≤12%.The primary outcomes were ICU mortality,hours in the ICU,duration of mechanical ventilation,and days off mechanical ventilation at 28 days.Non-parametric paired-sample tests were used to compare differences in baseline data and outcome indicators between the two groups,and the Kapan-Meier method was used to analyse the cumulative risk of in-hospital ICU mortality and 28-day unused mechanical ventilation time.Results There were no deaths in patients in the 4P group and the mortality rate was 2.70%(1 case)in the non-4P group,and there was no statistically significant difference in deaths between the two groups(P>0.05).The hours of ICU care in patients in the 4P group[150.00(123.50,203.00)h vs.205.00(148.50,306.50)h,P=0.017],the hours of mechanical ventilation[84.00(57.50,121.00)h vs.105.00(74.50,170.50)h,0.004]were shorter in the 4P group than in the non-4P group,the differences were statistically significant(P<0.05).The number of days without mechanical ventilation at 28-day was longer in the 4P group than in the non-4P group[24.50(22.96,25.60)d vs.23.63(20.90,24.90)d],the difference was statistically significant(P=0.004).The cumulative fraction curve showed a significant increase in the days without mechanical ventilation at 28-day in patients in the 4P group at the end of monitoring,the difference was statistically significant(P=0.018).There was no significant difference
作者
谭紫琪
苏龙翔
杨莹莹
池熠
陈翔宇
隆云
TAN Ziqi;SU Longxiang;YANG Yingying;CHI Yi;CHEN Xiangyu;LONG Yun(Department of Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中国卫生标准管理》
2024年第22期68-72,共5页
China Health Standard Management
基金
北京市科技计划课题(Z201100005520051)。
关键词
急性呼吸窘迫综合征
循环保护通气4P标准策略
机械通气时间
ICU监护时间
死亡率
预后
acute respiratory distress syndrome
4P strategy of circulatory protection ventilation
duration of mechanical ventilation
ICU monitoring time
mortality
prognosis
