高频震荡通气对急性呼吸窘迫综合征患者氧代谢和炎症因子的影响

Influence of high frequency oscillatory ventilation on oxygen metabolism and inflammatory factors of patients with acute respiratory distress syndrome

目的:探讨高频震荡通气(high frequency oscillatory ventilation,HFOV)对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者氧代谢和炎症因子的影响。方法 :70例ARDS患者随机分为HFOV组(35例)和CMV组(35例)。HFOV组采用HFOV进行治疗,CMV组采用常频机械持续控制通气(continuous mandatory ventilation,CMV)进行治疗,将两组患者治疗前后的氧代谢和炎症因子水平进行对比。结果:1治疗72 h后,两组患者的血流动力学[心率(heart rate,HR)、平均肺动脉压(mean pulmonary arterial pressure,MPAP)]、急性生理学与慢性健康状况评分(APACHEⅡ评分)、多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)评分、氧代谢指标[动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、动脉血氧分压与吸入氧浓度之比(PaO_2/FiO_2)]及炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、血清降钙素原(PCT)、肿瘤坏死因子α(TNF-α)]水平均较治疗前有显著改善(P<0.01或P<0.05),HFOV组的上述指标(除PaCO_2以外)较CMV组改善更显著(P<0.01或P<0.05)。2治疗35 d后,HFOV组患者的血管活性药物应用时间及ICU住院时间均短于CMV组(均P<0.05),两组患者的机械通气时间及病死率比较差异无统计学意义(均P>0.05)。两组均无气压伤等并发症发生。结论 :HFOV不但能改善氧合功能,而且能更有效地减轻肺部炎症反应,从而减轻肺组织损伤,降低APACHEⅡ评分、MODS评分,缩短血管活性药物应用时间和ICU住院时间。

Objective：To study the influence of high frequency oscillatory ventilation（HFOV） on oxygen metabolism and inflammatory factors of patients with acute respiratory distress syndrome（ARDS）. Methods： Seventy patients with acute respiratory distress syndrome（ARDS） were randomly divided into the HFOV group（35 cases） and continuous mandatory ventilation（CMV） group（35 cases）. The HFOV group accepted HFOV treatment and the CMV group received CMV therapy. Oxygen metabolism and inflammatory factor levels of patients in the two groups were compared before and after treatment. Results： 1 After 72 hours of treatment, hemodynamics（heart rate（HR）, mean pulmonary arterial pressure（MPAP）, APACHE Ⅱ score, multiple organ dysfunction syndrome（MODS） score, oxygen metabolism index（PaO2, Pa CO2 and PaO2/ FiO2） and inflammatory factor levels（hs-CRP, IL-6,PCT, and TNF-α） in the two groups were significantly improved compared with those before treatment（P〈0.01 or P〈0.05）, the above indexes（except for Pa CO2） in the HVHF group were more significant than those in the CMV group（P〈0.01 or P〈0.05）. 2After 35 days of treatment, the application time of vasoactive drugs and ICU in the HFOV group were shorter than that in the CMV group（all P〈0.05）, and no significant differences were found in the mechanical ventilation time and mortality of patients in the two groups（all P〉0.05）. There were no complications such as air pressure injury in the two groups. Conclusion： HFOV can not only improve oxygenation function, bu also more effectively reduce the inflammatory response in the lungs, so as to reduce the lung tissue injury,decrease the APACHE Ⅱ score and MODS score, and shorten hospitalization time of vasoactive drug application time and ICU.