肺复张联合双水平气道正压通气治疗急性呼吸窘迫综合征的研究

Clinical research on acute respiratory distress syndrome in the treatment with lung recruitment and Bi level positive airway pressure ventilation

目的探讨肺复张联合双水平气道正压通气治疗急性呼吸窘迫综合征的临床疗效。方法选取急性呼吸窘迫综合征患者76例,随机分为2组。对照组38例采用小潮气量辅助控制通气(潮气量为6 mL/kg)治疗,观察组38例采用肺复张联合双水平气道正压通气治疗,比较2组患者通气72 h后的各项临床指标。结果观察组呼吸机参数平台压、呼气末正压均略低于对照组,但均无显著性差异(P均>0.05)。观察组吸气峰压明显低于对照组,平均呼吸道压、潮气量、每分钟通气量均明显高于对照组。观察组pH值略高于对照组,但无显著性差异。观察组中心静脉压明显低于对照组,动脉血氧分压、氧合指数、肺顺应性及总有效率均明显高于对照组。结论采用肺复张联合双水平气道正压通气治疗急性呼吸窘迫综合征可以有效改善患者的氧合功能,明显提高患者肺的顺应性,大幅降低呼吸机的使用条件,是一种有效的治疗方法,值得临床推广使用。

Objective It is to investigate the clinical efficacy of lung recruitment and Bi level positive airway pressure ven- tilation on acute respiratory distress syndrome. Methods 76 patients with acute respiratory distress syndrome were selected and randomly divided into two groups. 38 patients in the control group were treated with low tidal volume assist control ventilation （ tidal volume was 6 mL/kg） , 38 patients in the observation group were treated with lung recruitment and Bi level positive air- way pressure ventilation. The clinical indexes were compared between the patients in both groups after 72 h~ ventilation. Re- suits The ventilator parameters plateau pressure and positive end expiratory pressure in the observation group were slightly low- er than those in the control group, but the difference was not statistically significant （ P 〉 0.05 ）. The ventilator parameters peak inspiratory pressure in the observation group was significantly lower than that in the control group. The ventilator parame- ters mean airway pressure, tidal volume, minute ventilation volume in the observation group were significantly higher than those in the control group. The difference was statistically significant. The pH in the observation group was slightly higher than that in the control group, but the difference was not statistically significant. The central venous pressure in the observation group was lower than that in the control group. The total effective rate, arterial oxygen partial pressure, oxygenation index, lung compliance in the observation group were significantly higher than those in the control group. Conclusion Using lung re- cruitment and Bi level positive airway pressure ventilation in the treatment of acute respiratory distress syndrome can effectively improve patient oxygen and function, which can also improve patient compliance of lung ventilator and reduce the using condi- tion, so this is a safe and effective treatment method, which is worthy of clinical use.