不同体位肺复张对重症肺炎患者的临床治疗效果和安全性对比探讨

Comparative discussion of clinical therapeutic effect and safety by pulmonary reexpansion in different positions on patients with severe pneumonia

目的探讨不同体位肺复张对重症肺炎患者的临床治疗效果和安全性。方法选取本院收治的87例重症肺炎患者为研究对象,将患者分为仰卧位肺复张组和俯卧位肺复张组,分别使用不同的肺复张方法进行治疗,比较两组的临床效果。结果复张后5 min、1 h,两组患者的HR、CI、MAP与复张前比较,差异无统计学意义(P>0.05),复张后5 min的CVP与复张前比较,差异有统计学意义(P<0.05),复张后1 h与复张前比较,差异无统计学意义(P>0.05);复张后5 min、1 h的Pa O2/Fi O2高于复张前,差异有统计学意义(P<0.05)。俯卧位肺复张组复张后5 min、1 h的Pa O2/Fi O2与仰卧位肺复张组比较,差异有统计学意义(P<0.05)。在肺复张前后无一例患者出现气胸、皮下气肿等并发症;两组患者复张后5 min、1 h的胃黏膜p H与复张前比较,差异无统计学意义(P>0.05),两组患者复张后5 min、1 h的胃黏膜p H比较,差异无统计学意义(P>0.05)。结论两种肺复张方法均能有效改善患者的血氧参数和呼吸功能,且俯卧位肺复张的效果稍显优势,需结合临床进行选择。

Objective To discuss the clinical effects and safety by pulmonary reexpansion in different positions on patients with severe pneumonia. Methods 87 patients with severe pneumonia admitted into our hospital were selected as the research objects and they were divided into the pulmonary reexpansion in supine position group and pulmonary reexpansion in prone position group.They were treated by different pulmonary reexpansions and their clinical effects were compared. Results There was no statistical difference of heart rate（HR）,cardiac index（CI）,mean arterial pressure（MAP） after reexpansion 5 min,1 h in patients of the two groups compared to before reexpansion（P〉0.05）,and there was a statistical difference of central venous pressure（CVP） in the two groups compared to before reexpansion（P〈0.05）,and there was no statistical difference of CVP in the two groups compared to before reexpansion（P〉0.05）.There was a statistical difference of Pa O2/Fi O2 in the two groups after reexpansion 5 min,1 h compared to before reexpansion（P〈0.05）.There was a statistical difference of Pa O2/Fi O2 in the two groups（P 〈0.05）.There were no cases of pneumothorax and subcutaneous emphysema and other complications;there was no statistical difference of p H for gastric mucosa after reexpansion 5 min,1 h in patients of the two groups compared to before reexpansion（P〉0.05）,and there was no statistical difference of p H for gastric mucosa after reexpansion 5 min,1 h in patients of the two groups（P〉0.05）. Conclusion Two pulmonary reexpansions both can effectively improve blood oxygen parameters and respiratory function of patients.The therapeutic effect by pulmonary reexpansion in prone position is better and clinical conditions need to be considered on selection.