限制性液体管理对山莨菪碱联合机械通气治疗急性肺损伤患者肺动态顺应性的影响

Effect of limited fluid management on pulmonar dynamic compliance in treating acute lung injury with anisodamine combined with mechanical ventilation

目的分析山莨菪碱联合机械通气治疗机械肺损伤的过程中，运用限制性液体管理，对患者肺动态顺应性的影响。方法选取2016年2月～2017年1月常山县人民医院诊疗的90例急性肺损伤患者，随机分为对照组和研究组，各45例，均给予山莨菪碱联合机械通气治疗，对照组进行常规护理，研究组实施限制性液体管理，严密观察各类指标，根据病情变化随时调整输液量。比较2组管理后6h、24h、48h、72h的肺动态顺应性，氧合指数、血气分析和结局。结果2组管理后6h肺动态顺应性相比，差异无统计学意义。研究组管理后24h、48h、72h肺动态顺应性明显高于对照组，差异均有统计学意义（t=3.519，t=5.622，t=7.090，P＜0.05）。研究组的氧合指数、PaO2、PaCO2改善均显著大于对照组，差异均有统计学意义（t=5.511，t=9.523，t=3.040，P＜0.05）；2组管理后的pH值进行比较，差异无统计学意义。2组ICU率、普通病房率比较差异无统计学意义。研究组死亡率13.33%，明显小于对照组死亡率24.44%，差异具有统计学意义（χ2=4.029，P＜0.05）。结论在山莨菪碱联合机械通气治疗急性肺损伤患者的过程中，进行限制性液体管理，可有效提高患者肺动态顺应性，减少病死率，临床可根据ALI实际情况实施运用。

Objective To analyze the effect of limited fluid management on pulmonary dynamic compliance in treating acute lung injury with anisodamine combined with mechanical ventilation.Methods90cases of patients with acute lung injury from February2016to January2017were randomly divided into control group and research group,with45cases for each and were provide with anisodamine combined with mechanical ventilation as treatment.Control group was provide with conventional nursing,while research group was provided with limited fluid management,strict observation of various indicators,adjust the amount of transfusion at any time according to the change of the disease.Two groups were compared for pulmonary dynamic compliance in6h,24h,48h and72h after management,oxygenation index,blood gas analysis and outcome.Results In comparing pulmonary dynamic compliance in6h after management between two groups,the difference had no statistical significance Pulmonary dynamic compliance in24h,48h and72h after management of research group were significantly higher than control group,with difference statistical significance(t=3.519,t=5.622,t=7.090,P<0.05).The improvement of oxygenation index,PaO2and PaCO2w in research group were significantly higher than control group,with difference having statistical significance(t=5.511,t=9.523,t=3.040,P<0.05).In comparison of pH value after management between two groups,the difference had no statistical significance.In comparison of ICU rate and public ward rate between two groups,the difference had no statistical significance.The mortality of control group was24.44%,which was obviously higher than that in research group with13.33%,and the difference had statistical significance(χ2=4.029,P<0.05).Conclusion In treating patients with acute lung injury via anisodamine combined with mechanical ventilation,limited fluid management can effectively improve pulmonary dynamic compliance of patients and reduce mortality.In clinic,it can be applied in accordance with ALI specific condition.