不同跨肺压机械通气治疗急性呼吸窘迫综合征的效果比较及对血流动力学的影响

Effect of different transpulmonary pressure mechanical ventilation on acute respiratory distress syndrome and its influence on hemodynamics

目的比较不同跨肺压(Ptp)机械通气治疗急性呼吸窘迫综合征的效果及对血流动力学的影响。方法选取我院2017年3月-2019年3月收治的88例急性呼吸窘迫综合征患者为研究对象,所有患者依据随机数表法分为4组,即对照组、A组、B组、C组,每组22例。对照组参照《急性呼吸窘迫综合征患者机械通气指南》进行治疗,A、B、C组调节呼气末正压(PEEP)后设定不同Ptp治疗,分别为10、15、20cmH2O。对比4组治疗后12、24、48h血气分析指标[动脉血氧分压(Pa02)、二氧化碳分压(PaC02)、氧合指数(Pa02/Fi02)]及呼吸力学指标[肺顺应性(Cst)、PEEP、血管外肺水指数(ELWI)]变化,对比4组治疗前后血流动力学指标[平均动脉压(MAP)、中心静脉压(CPV)、心指数(CI)、收缩压(SBP)、舒张压(DBP)、心率(HR)]变化,另外统计4组治疗后28 d预后情况。结果4组不同时点PaO2、PaCo2、PaO2/FiO2水平呈上升趋势,12h<24h<48h,差异有统计学意义(P<0.05)。4组不同时点Cst、PEEP水平呈上升趋势,12h<24h<48h,差异有统计学意义(P<0.05);4组不同时点ELWI水平呈下降趋势,12h>24h>48h,差异有统计学意义(P<0.05)。对照组、B组、C组治疗后MAP、DBP、HR水平与治疗前对比显著降低,差异有统计学意义(P<0.05);对照组、B组、C组治疗后CI水平与治疗前对牝显著提高,差异有统计学意义(P<0.05)。对照组治疗后死亡率为22.73%,A组为9.09%,B组为13.64%,C组为18.18%,4组死亡率的差异无统计学意义(P>0.05)。结论Ptp为10cmH2O时机械通气治疗急性呼吸窘迫综备征可改善患者氧合及呼吸力学指标,且血流动力学稳定,安全性较高,值得临床应用。

Objective To study the effect of different transpulmonary pressure(Ptp)mechanical ventilation on acute respiratory distress syndrome(ARDS)and its influence on hemodynamics.Methods Eighty-eight patients with acute respiratory distress syndrome(ARDS)admitted to our hospital from March 2017 to March 2019 were selected as the subjects.All patients were divided into control group,group A,group B and group C according to random number table method,with 22 cases in each group.The control group was treated with mechanical ventilation guide for patients with acute respiratory distress syndrome.Groups A,B and C were given different Ptp treatments after PEEP adjustment,respectively 10,15 and 20cmH2O.Blood gas analysis indexes[Pa02,PaC02,Pa02/Fi02]and respiratory mechanics indexes[Cst,PEEP,ELWI]were compared at 12h,24h and 48h after treatment in the four groups.Hemodynamic indexes[MAP,CPV,CI,SBP,DBP,HR]were compared before and after treatment in the four groups.In addition,the prognosis of the four groups after 28 days of treatment was counted.Results The levels of Pa02,PaC02 and Pa02/Fi02 in the four groups at different time points showed an upward trend,12 h<24 h<48 h,the difference was statistically significant(P<0.05).The levels of Cst and PEEP in the four groups at different time points showed an upward trend,12 h<24 h<48 h,the difference was statistically significant(P<0.05).ELWI levels in the four groups at different time points showed a downward trend,12 h>24 h>48 h,the difference was statistically significant(P<0.05).The levels of MAP,DBP and HR in control group,B group and C group were significantly lower than those before treatment(P<0.05).The CI level of control group,B group and C group after treatment was significantly higher than that before treatment,and the difference was statistically significant(P<0.05).After treatment,the mortality rate of the control group was 22.73%,that of group A was 9.09%,that of group B was 13.64%,and that of group C was 18.18%.There was no significant difference between the four groups(P>0.05).Conclusion Mechanical ventilation at Ptp of 10cmH2O can improve oxygenation and respiratory mechanical indexes of patients with acute respiratory distress syndrome,and the hemodynamics is stable and safe,which is worthy of clinical application.