液体负平衡对腹部损伤并ARDS肺功能保护的临床研究

Clinical study on protective effect of negative fluid balance on pulmonary function in abdominal trauma and ARDS

目的探讨液体负平衡对腹部损伤并急性呼吸窘迫综合征(ARDS)患者肺功能的保护作用及其可能机制。方法将130例ARDS患者分为液体负平衡组(观察组)和对照组,每组65例。对照组患者采用常规机械通气、抗感染治疗,观察组患者在对照组的基础上,采取一定的措施保持液体负平衡。观察并记录两组患者血流动力学指标、肺部炎症因子水平及呼吸机机械通气情况。结果治疗后两组患者心脏指数(CI)、心排出量(CO)值正常,心功能未受到影响,观察组患者血管外肺水含量指数(EVLWI)值下降更明显,肺水肿症状改善明显;两组患者肺部炎症均得到控制,肺功能均有所改善,但观察组患者效果更显著;与对照组比较,观察组患者平均通气时间更短,两组比较差异有统计学意义(P<0.05)。结论腹部损伤并ARDS治疗中,保持患者液体负平衡,对患者肺部功能保护较好,值得临床推广与使用。

Objective To investigate the protective effect of the negative fluid balance on the lung function in abdominal trau- ma and acute respiratory distress syndrome（ARDS） and its possible mechanism. Methods Totally 130 ARDS patients were ran- domly divided into the negative fluid balance group （observation group, 65 cases） and the control group （65 cases）. The control group was treated with therapy of the conventional mechanical ventilation and anti-infection, while on this basis the observation group adopted certain measure for maintaining the negative fluid balance. The hemodynamic indexes,pulmonary inflammatory factor levels and mechanical ventilation conditions were observed and recorded in the two groups. Results The cardiac index （CI） and car- diac output （CO） value after treatment in the two groups were normal and the heart function was not affected,the decrease of the extravascular lung water index （EVLWI） in the observation group was more obvious and the improvement of pulmonary edema symptoms was more significant;the pulmonary inflammation in the two groups was controlled, and the pulmonary function was im- proved to some extent,but the effect in the observation group was more significant ; the average ventilation time in the observation group was shorter,which could significantly reduce the ventilator support intensity,the differences between the two groups were statistically significant（P〈0.05）. Conclusion Maintaining the negative fluid balance in the treatment of abdominal trauma compli- cating ARDS has the better effect for protecting the pulmonary function and is worthy of being clinically promoted and applied.