早期呼吸机治疗对急性呼吸窘迫综合征患者肺循环功能及炎症反应的影响

Effect of early ventilator therapy on pulmonary circulation function and inflammatory reaction in patients with acute respiratory distress syndrome

目的探讨早期呼吸机治疗对急性呼吸窘迫综合征(ARDS)患者肺循环功能和黏结蛋白聚糖-1(Syndecan-1)水平的影响。方法选取ARDS患者80例,根据治疗方法的不同分为对照组和观察组,每组40例。所有患者均给予常规对症治疗,对照组应用常规呼吸机治疗,观察组应用同步早期呼吸机治疗。比较2组患者的临床效果。比较2组患者肺循环指标[肺循环阻力(PVR)、血管外肺水(EVLW)、平均肺动脉压(MPAP)、右室每搏功指数(RVSWI)]、血气指标{动脉血氧分压[p a(O 2)]、动脉血二氧化碳分压[p a(CO 2)]、氧合指数[p a(O 2)/FiO 2]、血氧饱和度(SaO 2)}以及降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、中性粒细胞弹性蛋白酶(NE)、Syndecan-1水平。比较2组患者并发症发生情况及急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分。结果治疗后,观察组患者PVR、EVLW、MPAP水平高于对照组,RVSWI水平低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组患者p a(O 2)、p a(O 2)/FiO 2、SaO 2水平高于对照组,p a(CO 2)水平低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组患者PCT、IL-18、TNF-α、NE、Syndecan-1水平低于对照组,差异有统计学意义(P<0.05)。观察组患者并发症发生率为17.50%,低于对照组的42.50%,差异有统计学意义(P<0.05)。治疗后,观察组患者APACHEⅡ评分为(12.01±3.12)分,低于对照组的(17.29±3.48)分,差异有统计学意义(P<0.05)。结论早期应用呼吸机治疗可有效降低ARDS患者呼吸机相关并发症的发生率,抑制炎症反应,改善患者肺循环功能。

Objective To investigate the effect of early ventilator therapy on pulmonary circulation function and Syndecan-1 level in patients with acute respiratory distress syndrome(ARDS).Methods Totally 80 patients with ARDS were selected and divided into control group and observation group according to different therapeutic plans,with 40 cases in each group.All patients were treated with conventional symptomatic treatment.The control group was given conventional ventilator treatment,and the observation group was given synchronous early ventilator treatment.The clinical effect was compared between the two groups.Pulmonary circulation indexes[pulmonary circulation resistance(PVR),extravascular lung water(EVLW),mean pulmonary artery pressure(MPAP),right ventricular stroke work index(RVSWI)],blood gas indexes including arterial partial pressure of oxygen[p a(O 2)],arterial partial pressure of carbon dioxide[p a(CO 2)],oxygenation index[p a(O 2)/FiO 2],blood oxygen saturation(SaO 2),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),neutrophil elastase(NE)and Syndecan-1 were compared between two groups.Incidence ofcomplications and score of Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)were compared between the two groups.Results After treatment,the levels of PVR,EVLW and MPAP in the observation group were significantly higher than those in the control group,while the RVSWI level in the observation group was significantly lower than that in the control group(P<0.05).After treatment,the levels of p a(O 2),p a(O 2)/FiO 2 and SaO 2 in the observation group were significantly higher than those in the control group,while the p a(CO 2)level was significantly lower than the control group(P<0.05).After treatment,the levels of PCT,IL-18,TNF-α,NE and Syndecan-1 in the observation group were significantly lower than those in the control group(P<0.05).The incidence of complications in the observation group was 17.50%,which was significantly lower than 42.50%in the control group(P<0.05).After treatment,the score of APACHEⅡin the observation group was(12.01±3.12)points,which was significantly lower than(17.29±3.48)points in the control group(P<0.05).Conclusion For patients with ARDS,early application of ventilator therapy can effectively reduce the incidence of ventilator-related complications,inhibit inflammatory reactions and improve pulmonary circulation function.