俯卧位通气联合肺复张治疗重症ARDS的效果及对氧合变化和预后的影响

Effect of Prone Position Ventilation Combined with Pulmonary Retentions on the Treatment of Severe ARDS and its Effect on Oxygenation and Prognosis

目的:研究俯卧位通气联合肺复张治疗重症急性呼吸窘迫综合征(ARDS)的效果及对患者氧合变化和预后的影响。方法:选取我院于2017年4月—2020年3月期间收治的88例重症ARDS患者为研究对象,按治疗方案分为对照组(n=44)和观察组(n=44),对照组应用呼吸正压通气治疗方案,观察组采取俯卧位通气联合肺复张治疗方案,对两组患者治疗前后氧化变化、血流动力学指标及预后情况进行比较和评价。结果:治疗前两组患者PaO2、PaO2/FiO2对比差异不明显(P>0.05);治疗后观察组PaO2、PaO2/FiO2均高于对照组(P<0.05)。治疗前两组患者MAP、HR、CVP水平对比差异不明显(P>0.05);治疗后观察组CVP高于对照组(P<0.05)。观察组28天病死率及机械通气时间、入住ICU时间、不良事件发生率均低于对照组(P<0.05)。结论:对重症ARDS采用俯卧位通气联合肺复张治疗效果尤为显著,可以有效改善患者机体氧合状态及预后效果,值得临床应用。

Objective:To study the effect of prone position ventilation combined with pulmonary retentions in the treatment of severe acute respiratory distress syndrome(ARDS)and its effect on the oxygenation and prognosis of patients.Methods:Our hospital in April 2017-March 2020 treated 88 cases of severe ARDS patients as the research object,according to the treatment scheme is divided into the control group(n=44)and observation group(n=44),respiratory control application positive pressure ventilation therapy,observation group take the prone position ventilation combined lung after treatment,before and after treatment in patients with two groups of oxidation changes,hemodynamic indexes and prognosis compared and evaluated.Results:There was no significant difference in PaO2 and PaO2/FiO2 between the two groups before treatment(P>0.05).After treatment,both PaO2 and PaO2/FiO2 in the observation group were higher than those in the control group(P<0.05).There was no significant difference in MAP,HR and CVP between the two groups before treatment(P>0.05).CVP of the observation group was higher than that of the control group after treatment(P<0.05).The 28-day fatality rate,mechanical ventilation time,ICU stay time and adverse event rate in the observation group were all lower than those in the control group(P<0.05).Conclusion:The treatment of severe ARDS with prone position ventilation combined with pulmonary retraction is particularly effective,which can effectively improve the oxygenation status and prognosis of patients,and is worthy of clinical application.