无创正压通气辅助治疗重症急性胰腺炎伴急性呼吸窘迫综合征最佳吸气压力探讨

Study on the Optimal Inspiratory Pressure in the Treatment of Severe Acute Pancreatitis with Acute Respiratory Distress Syndrome by Non-invasive Positive Pressure Ventilation

目的探讨无创正压通气辅助治疗重症急性胰腺炎伴急性呼吸窘迫综合征(ARDS)的最佳吸气压力。方法选取重症急性胰腺炎伴ARDS进行无创正压通气辅助治疗的患者80例,采用随机数字表法分为对照组和观察组各40例,对照组给予吸气压力17～20cmH2O,观察组给予吸气压力12～16cmH_2O,两组患者呼气压力均为4～8cmH_2O,比较两组患者无创正压通气治疗24小时后氧分压(PaO_2)、二氧化碳分压(PaCO_2)、血氧饱和度(SaO_2)、p H、潮气量、气流舒适度、恐惧感、腹胀感及依从性方面的差异。结果治疗24小时后,观察组PaO_2(96. 40±4. 30) mm Hg、PaCO2(37. 30±2. 80) mmHg、SaO_2(96. 10±1. 50)%,明显高于治疗前PaO_2(68. 30±4. 60) mm Hg、PaCO_2(24. 30±3. 20) mm Hg、SaO_2(92. 10±1. 80)%,治疗前后比较差异有统计学意义(P<0. 05);对照组治疗后PaO_2(96. 10±4. 80) mm Hg、PaCO_2(39. 60±3. 2) mm Hg、SaO_2(96. 90±1. 80)%,明显高于治疗前PaO_2(67. 90±5. 10) mm Hg、PaCO_2(23. 90±3. 80) mm Hg、SaO_2(92. 80±1. 30)%,治疗前后比较差异有统计学意义(P<0. 05),但两组间治疗后PaO_2、PaCO_2、Sa O_2比较差异无统计学意义(P>0. 05);观察组患者治疗前后p H分别为(7. 32±0. 04,7. 39±0. 04),对照组治疗前后p H分别为(7. 31±0. 03,7. 38±0. 04),两组患者治疗后p H值较治疗前均有改善,但与治疗前比较及组间比较差异无统计学意义(P>0. 05);治疗后观察组潮气量、气流舒适度、恐惧感、腹胀感分别为(379. 00±107. 00) m L、(3. 60±1. 40)分、(3. 90±1. 10)分、(5. 00±1. 40)分,明显低于对照组(468. 00±120. 00) ml、(6. 70±1. 60)分、(6. 60±1. 20)分、(7. 10±1. 80)分,两组比较差异有统计学意义(P<0. 05);观察组患者对无创正压通气治疗的依从性高于对照组,差异有统计学意义(P<0. 05)。结论无创正压通气辅助治疗重症急性胰腺炎伴ARDS采用12～16cmH_2O吸气压力既能有效改善患者的呼吸功能,迅速纠正低氧血症,同时又能提高患者的的舒适度,从而提高患者对无创正压通气治疗的耐受性和依从性,保证无创正压通气治疗顺利实施,值得临床推广应用。

Objective To explore the best inspiratory pressure of noninvasive positive pressure ventilation in the treatment of severe acute pancreatitis with acute respiratory distress syndrome(ARDS). Methods Eighty patients with severe acute pancreatitis combined with ARDS treated with non-invasive positive pressure ventilationwere selected and randomly divided into control group( n =40)and observation group( n =40).The inspiratory pressure was 17~20cmH2Oin the control group and 12~16cmH 2 Oin the observation group.The expiratory pressure of both groups was 4~8cmH2O.The differences of oxygen partial pressure(PaO2 ),partial pressure of carbon dioxide(PaCO2 ),blood oxygen saturation(SaO2 ),pH,moisture,airflow comfort,fear,abdominal distension and compliance were compared between the two groups after 24 hours of non-invasive positive pressure ventilation. Results After 24 hours of treatment,the PaO2 (96.40±4.30)mmHg、PaCO2 (37.30±2.80)mmHg、SaO2 (96.10±1.50)% in the observation group were significantly higher than those before treatment,which were PaO2 (68.30±4.60)mmHg、PaCO2 (24.30±3.20)mmHg、SaO2 (92.10±1.80)%,and the difference before and after treatment was statistically significant( P <0.05);In the control group,after treatment,the PaO 2 (96.10±4.80)mmHg、PaCO 2 (39.60±3.2)mmHg、SaO 2 (96.90±1.80)% were obviously higher than those before treatment,which were PaO 2 (67.90±5.10)mmHg、PaCO 2 (23.90±3.80)mmHg、SaO 2 (92.80±1.30)%,and the difference before and after treatment was statistically significant( P <0.05).However,there was no significant difference in PaO2 ,PaCO2 and SaO2 between the two groups after treatment( P >0.05).pH was(7.32 ±0.04,7.39 ±0.04)before and after treatment in the observation group and(7.31 ±0.03,7.38 ±0.04)before and after treatment in the control group.The pH values of the two groups were improved after treatment.But there was no significant difference between the two groups before and after treatment( P >0.05).After treatment,the tidal volume,airflow comfort,fear and abdominal distension in the observation group were(379.00±107.00)ml,(3.60±1.40),(3.90±1.10)and(5.00±1.40),respectively,which were significantly lower than those in the control group(468.00 ±120.00)ml,(6.70±1.60),(6.60±1.20),(7.10±1.80),and the difference between the two groups was statistically significant( P <0.05).The compliance of the patients in the observation group with noninvasive positive pressure ventilation was higher than that in the control group( P <0.05). Conclusion Non-invasive positive pressure ventilation in the treatment of severe acute pancreatitis combined with ARDS with 12~16cmH2O inspiratory pressure can effectively improve the respiratory function of patients,quickly correct hypoxemia,and also improve the comfort of patients,so as to improve the patients tolerance and compliance to the treatment of non-invasive positive pressure ventilation,and to ensure the smooth implementation of non-invasive positive pressure ventilation therapy.It is worthy of clinical application.