俯卧位通气联合小肠造瘘喂养在食管癌术后合并重度急性呼吸窘迫综合征患者中的应用

Application of ventilation in prone position combined with feeding via enterostomy in postoperative esophageal cancer patients complicated with severe acute respiratory distress syndrome

目的观察俯卧位通气联合小肠造瘘喂养治疗食管癌术后并发重度急性呼吸窘迫综合征(ARDS)患者的效果。方法将64例食管癌术后并发重度ARDS患者随机分为两组,每组32例。观察组患者采取俯卧位机械通气联合小肠造瘘进行肠内营养治疗,对照组患者采取常规体位进行机械通气加肠外营养治疗。观察两组患者机械通气开始时、机械通气24 h、机械通气72 h时血清肿瘤坏死因子α(TNF-α)水平、白细胞介素6(IL-6)水平及Murray急性肺损伤评分;观察两组患者机械通气开始时、机械通气1 h、机械通气24 h、机械通气72 h时血气分析指标;比较两组脱离呼吸机时间、住ICU时间及急性生理学和慢性健康状态评估Ⅱ(APACHEⅡ)评分,治疗后1个月存活率。结果机械通气1 h、机械通气24 h、机械通气72 h时,观察组TNF-α水平、IL-6水平、Murray急性肺损伤评分均低于对照组;PaO2/吸入氧气分数(FiO2)、pH、FiO2高于对照组,吸入二氧化碳分数低于对照组;脱机时间长于对照组,ICU停留时间短于对照组,APACHEⅡ评分低于对照组(均P<0.05)。治疗1个月后,观察组存活率高于对照组(P<0.05)。结论俯卧位通气联合小肠造瘘肠内营养治疗食管癌术后并发重度ARDS患者,能更好改善患者氧合,降低肺损伤程度,减轻炎症反应,改善患者预后。

Objective To observe the effect of ventilation in prone position combined with feeding via enterostomy on patients complicated with severe acute respiratory distress syndrome(ARDS) after esophageal cancer surgery. Methods Sixty-four patients complicated with severe ARDS after esophageal cancer surgery were randomly divided into two groups,with 32 cases in each group.Patients in the observation group received mechanical ventilation in prone position combined with enterostomy for enteral nutrition,while patients in the control group received mechanical ventilation in conventional position combined with parenteral nutrition.At the beginning,24 and 72 hours of mechanical ventilation,serum tumor necrosis factor α(TNF-α) level and interleukin 6(IL-6) level as well as Murray acute lung injury score were observed in both groups;blood gas analysis indicators were observed in the two groups at the beginning,1,24 and 72 hours of mechanical ventilation;the two groups were compared with respect to ventilator withdrawal time,ICU stay, the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score,and survival rate at month 1 after treatment. Results At 1,24 and 72 hours of mechanical ventilation,the observation group exhibited lower TNF-α levels,IL-6 levels and Murray acute lung injury scores,higher PaO 2/fraction of inspired oxygen(FiO 2),pH and FiO 2,lower fraction of inspired carbon dioxide,longer ventilator withdrawal time,shorter ICU stay,and lower APACHEⅡ scores as compared with the control group(all P <0.05).After 1 month of treatment, the survival rate in the observation group was higher than that in the control group( P <0.05). Conclusion Ventilation in prone position combined with feeding via enterostomy can better improve oxygenation,ameliorate lung injury,alleviate inflammation response,and promote prognosis in patients complicated with severe ARDS after esophageal cancer surgery.