比较不同体位下联合肺复张治疗对ARDS的疗效分析

To Compare the Curative Effect of Combined Lung Resection on ARDS in Different Positions

目的观察仰卧位及俯卧位间断联合肺复张治疗ARDS的临床疗效进行对比分析,为临床治疗提供参考依据。方法收集重症医学科2013年1月-2017年1月收治的40例患者作为研究对象,40例患者均已确诊为ARDS,所有患者均给予机械通气治疗。根据机械通气过程中不同体位分为仰卧位组和俯卧位组,每组各20例。比较两组患者肺复张前后血流动力学指标的变化:心率(HR)、中心静脉压(CVP)、平均动脉压(MAP);比较两组患者肺复张前后血气分析各项指标的变化:PH、Pa O_2、Pa CO_2、Pa O_2/Fi O_2;比较两组患者机械通气时间、ICU治疗时间及死亡率。结果两组患者肺复张前与肺复张后HR、CVP、MAP比较,差异无统计学意义(P>0.05),俯卧位肺复张后与仰卧位肺复张后HR、CVP、MAP比较,差异无统计学意义(P>0.05)。两组患者肺复张前与肺复张后比较PH、Pa O_2、Pa O_2/Fi O_2值增高,Pa CO_2值降低,差异有统计学意义(P<0.05),俯卧位组肺复张后Pa O_2、Pa O_2/Fi O_2大于仰卧位组肺复张后,差异有统计学意义(P<0.05)。俯卧位组机械通气时间、ICU治疗时间及死亡率均低于仰卧位组,差异有统计学意义(P<0.05)。结论俯卧位通气联合肺复张治疗ARDS可使患者血流动力学指标保持稳定的同时,有效地改善患者氧合功能及提高生存质量,是可行的治疗手段,值得在临床上应用推广。

Objective To observe the clinical efficacy of supine position and prone position discontinuance combined with pulmonary resuscitation to treat ARDS,and to provide a reference for clinical treatment. Methods The 40 patients admitted to the intensive care department of our hospital from January 2013 to January 2017 were selected as the study subjects. All of the 40 patients had been diagnosed as ARDS,and all patients were treated with mechanical ventilation. According to the mechanical ventilation,different positions were divided into the supine position group and the prone position group,with 20 cases in each group. The changes of hemodynamic indexes were compared between the two groups： heart rate（ HR）,central venous pressure（ CVP） and average arterial pressure（ MAP）. Compare the changes in the indexes of blood gas analysis of the two groups of patients before and after the lung resection： PH、Pa O2、Pa CO2、Pa O2/Fi O2; Compared the mechanical ventilation time,ICU treatment time and mortality of the two groups. Results Two groups of patients with lung protracted war after zhang before and lung after HR,CVP,comparison of the MAP,there was no statistically significant difference（ P〈0. 05）,the prone position lung protracted war after protracted war and supine lung after HR,CVP,comparison of the MAP,there was no statistically significant difference（ P〈0. 05）. Two groups of patients with lung after zhang before and lung after protracted war is higher PH、Pa O2、Pa O2/Fi O2、Pa CO2 value is reduced,the difference was statistically significant（ P〈0. 05）,lung after protracted war prone position group Pa O2、Pa O2/Fi O2 protracted war is greater than the lung after supine group,the difference was statistically significant（ P〈0. 05）. The mechanical ventilation time,ICU treatment time and mortality were lower than those in the supine position group,and the difference was statistically significant（ P〈0. 05）. Conclusions Prone position ventilation combined lung after a treatment of patients with ARDS can make stable hemodynamic parameters at the same time,effectively improve patients oxygenation function and improve the quality of survival,is feasible treatments,is worth popularizing in clinical application.