肺复张治疗对重症肺部感染患者血流动力学及氧合水平的影响分析

Influence pulmonary reexpansion treatment on hemodynamics and oxygenation level of patients with severe pulmonary infections

目的研究俯卧位肺复张在重症肺部感染出现低氧血症患者中的应用效果。方法选取2013年4月-2015年4月医院接诊的75例重症肺部感染合并低氧血症的患者进行研究,按照随机数表法将患者分为两组,试验组45例患者实施俯卧位肺复张治疗,对照组30例实施仰卧位肺复张,检测两组患者肺复张前后基础指标、血流动力学及氧合指标的变化情况,并比较两组患者肺复张后不良反应发生情况。结果肺复张前,两组患者的各项生命体征均无显著性差异;肺复张后,两组患者的心率(HR)及平均动脉压(MAP)均有所下降,但与复张前无显著性差异;血氧饱和度(SpO_2)和氧合指数(PaO_2/FiO_2)水平均明显升高(P<0.05);试验组SpO_2和PaO_2/FiO_2水平明显高于对照组(P<0.05);肺复张前,两组患者的血流动力学各项指标无明显变化;肺复张后,两组患者的中心静脉压(CVP)、每搏指数(SVI)及全心射血分数(GEF)水平均明显降低,全身血管阻力(SVRI)水平明显升高(P<0.05);试验组患者肺复张后不良反应发生率为4.44%,对照组为20.00%,两组比较差异有统计学意义(P<0.05)。结论俯卧位和仰卧位肺复张均能显著改善患者的血氧及血流动力学状况,但俯卧位肺复张的治疗效果及安全性均较高,值得广泛推广应用。

OBJECTIVE To observe the effect of prone pulmonary reexpansion on treatment of severe pulmonary in-fection patients with hypoxemia.METHODS A total of 75 severe pulmonary infection patients complicated with hy-poxemia who were treated in the hospital from Apr 2013 to Apr 2015 were enrolled in the study and randomly di-vided into the observation group with 45 cases and the control group with 30 cases.The observation group was treated with prone pulmonary reexpansion,and the control group was given supine pulmonary pulmonary reexpan-sion.The primary indexes,hemodynamics indexes and oxygenation indexes of the two groups of patients were de-tected before and after the pulmonary reexpansion,and the incidence of adverse reactions was observed and com-pared between the two groups of patients after the pulmonary reexpansion.RESULTS There was no significant difference in the the vital signs between the two groups of patients before the pulmonary reexpansion.The heart rate（HR）and mean arterial pressure（MAP）of the two groups of patients were reduced after the pulmonary re-expansion,however,there were no significant differences before and after the pulmonary reexpansion.The levels of oxyhemoglobin saturation（SpO2）and oxygenation index（PaO2/FiO2）were significantly elevated after the pul-monary reexpansion（P〈0.05）.The levels of SpO2and PaO2/FiO2of the observation group were significantly higher than those of the control group（P〈0.05）;there were no significant differences in the hemodynamics inde-xes between the two groups of patients.The central venous pressure（CAP）,stroke volume index（SVI）and heart ejection fraction（GEF）levels of the two groups of patients were significantly reduced after the pulmonary reexpansion,while the systemic vascular resistance（SVRI）level was significantly elevated（P〈 0.05）.The incidence of adverse reactions of the observation group was 4.44% after the pulmonary reexpansion,the control group 20.00%,and there was significant difference between the two groups（P〈0.05）.CONCLUSION The prone and supine pulmonary reexpansion may significantly improve the blood oxygen and hemodynamics of the patients, and the prone pulmonary reexpansion can achieve higher therapeutic effect and safety,it is worthy to be promoted in the hospital.