肺开放通气治疗重症急性胰腺炎并发ARDS的临床研究

Open lung ventilation in the treatment of severe acute pancreatitis complicated by ARDS in clinical research

目的比较肺开放式通气治疗与常规通气治疗对于重症急性胰腺炎(SAP)合并急性呼吸窘迫综合征(ARDS)患者的治疗效果。方法选取40例在治疗的SAP合并ARDS患者,按照通气方式不同分为观察组和对照组,观察组16例采用肺开放式通气治疗,对照组24例采取常规通气治疗,比较两组患者治疗前后不同时间段的动脉血气变化。结果①组内比较,两组患者在不同的治疗方式下通气治疗,PaO2,PaCO2和SaO2在治疗8、16、24、48 h后均较治疗前明显改善(P<0.05);②组间比较发现,观察组患者PaO2、SaO2和PaO2/FiO2在治疗后16、24 h明显高于对照组(P<0.05),而两组患者在治疗48 h后PaO2,PaCO2,pH,SaO2,PaO2/FiO2等血气分析指标差异无统计学意义(P>0.05),提示肺开放通气治疗方式相对于非开放式通气治疗在短时间内更为有效。③在小潮气量、低PEEP水平维持下,逐步提高PEEP,VT和FiO2水平,观察组16例患者中12例首次肺开放通气即改善明显,3例患者2次开放通气有效,1例患者失败,操作过程中患者HR,MAP均较为稳定;另外,无气胸、纵膈气肿等严重并发症。结论肺开放通气治疗能够在短时间内改善呼吸功能,且安全性较高。

Objective To compare the treatment efficacy of open lung ventilation with conventional ventilation in patients with acute respiratory distress syndrome （ARDS） combined with severe acute pancreatitis （SAP）. Methods Forty cases SAP combined with ARDS pa- tients in our department treated in accordance with thevenfilation mode were divided into observation group and control group. Twenty-four cases in control group underwent the conventional ventilation for treatment; 16 cases in observation group underwent open lung ventilation for treat- ment. The arterial blood gases in different time points of the two groups were compared before and after treatment. Results ① lntra-group comparison： for patients in the two groups treated with different types of ventilation, PaO2, PaCO2 and SaO2 after 8h, 16h, 24h and 48h treat- ment were improved significantly compared with those before treatment （P 〈0.05 ）. ② Inter-group comparison found that in the observation group, PaO2, SaO2 and PaO2/FiO2 afterl6h, 24h treatment were significantly higher （P 〈0.05 ）. Such blood gas analysis index as PaO2, Pa- CO2, pH, SaO2 and PaO2/FiO2 in two groups of patients after 48h treatment showed no significant difference, suggesting that compared with non-open ventilation treatment, the treatment of open lung ventilation was more effective in a short time. ③ In the low tidal volume and low PEEP levels, the level of PEEP VT and FiO2 was maintained and gradually improved. In the observation group, 12 out of the 16 cases were im- proved significantly for the first time open lung ventilation, three cases showed efficiency for the first and second time opening lung ventilation, and 1 case failed. HR and MAP of patients during the operation were relatively stable. In addition, no serious complications such as pneumotho- rax and pneumomediastinum occurred. Conclusion The open lung ventilation therapy can improve the respiratory function in a short period of time, and it shows higher security.