不同通气策略在ARDS治疗中的临床疗效观察

Clinical observation of different ventilation strategies in the treatment of acute respiratory distress syndrome

目的探讨不同通气策略对急性呼吸窘迫综合征（ARDS）患者低氧血症及血流动力学的影响。方法选择本院2012年7月~2015年2月收治的71例ARDS患者,符合纳入标准的63例,分为3组,每组21例,分别为常规机械通气组（SP）、肺开放组（RM）和俯卧位机械通气组（PP）。记录各组实施后24 h和48 h的血氧分压（PaO_2）、血氧饱和度（SpO_2）、二氧化碳分压（PaCO_2）、氧合指数（PaO_2/FiO_2）及肺开放和俯卧位通气前后心率（HR）、中心静脉压（CVP）、平均动脉压（MAP）。结果肺开放组和俯卧位组通气后24 h和48 h的PaO_2、SpO_2、PaO_2/FiO_2与常规机械通气组通气后24 h和48 h比较有明显的增加（P〈0.01）。三组通气后24 h和48 h的PaCO_2差异无统计学意义（P〉0.05）。肺开放后CVP短暂升高、MAP下降,结束肺开放后逐渐恢复至基础值。肺开放前后HR无明显变化,俯卧位通气前后CVP、MAP、HR均无明显变化（P〉0.05）。结论肺开放和俯卧位通气在急性呼吸窘迫综合征治疗中的临床治疗效果优于常规机械通气,肺开放对血流动力学有短暂影响,俯卧位通气对血流动力学无明显影响。

Objective To evaluate the effect of different ventilation methods on the patients with acute respiratory dis- tress syndrome（ARDS） in hypoxemia and hemodynamics. Methods 71 cases of ARDS patients were collected from July 2012 to February 2015 in our hospital,and 63 patients accorded with this standard were divided into three groups, each group of 21 cases, conventional mechanical ventilation group（SP）, recruitment maneuvers group（RM） and prone position ventilation group （PP）. Partial pressure of blood oxygen （PaO2）, oxygen saturation （SpO2）, partial pressure of blood car- bon dioxide （PaCO2）, oxygenation index （PaO2/FiO2） in these three groups were recorded after 24 hours and 48 hours of the treatments. Heart rate（HR）, central venous pressure（CVP） and mean arterial pressure（MAP） in PP and RM groups were measured before and after the ventilation. Results Compared to the SP group, PaO2, SpO2, PaO2/FiO2 in RM and PP groups were remarkably increased after 24 hours and 48 hours of the treatments of RM and PP （P〈0.01）. There was no significant difference in PaCO2 among these three groups （P〉0.05）. When the patients in RM groups received the treatment of RM, CVP had transiently increased, and MAP bad transiently decreased, then both of them had gradually returned to base values at the end of RM, but there was no significant difference in HR between before and after RM （P〉 0.05）. There were also no significant difference in CVP, MAP and HR between before and after PP （P〉0.05）. Con- clusion The clinical efficacy of recruitment maneuvers and prone position ventilation in the treatment of acute respira- tory distress syndrome were better than conventional mechanical ventilation. Recruitment maneuvers have transiently impact on hemodynamics, but there is no significant effect of prone position ventilation on hemodynamics.