不同肺复张方式对重度肺外源性急性呼吸窘迫综合征患者的影响分析

Effect of different recruitment maneuvers on patients with severe extrapulmonary acute respiratory distress syndrome

目的:分析不同肺复张方式对重度肺外源性急性呼吸窘迫综合征患者的影响。方法:回顾性分析某院收治的78例重度肺外源性急性呼吸窘迫综合征患者临床资料,根据其肺复张方式分为对照组(37例)与观察组(41例)。观察组行控制性膨胀肺复张,对照组行压力性控制肺复张,比较2组患者各时间点血气指标、呼吸力学指标及血流动力学指标的变化。结果:2组患者治疗24、72 h后氧合指数(PaO2/FiO2)较治疗前逐步升高,气道峰压(PIP)、平台压(Pplat)较治疗前逐步降低,差异有统计学意义(P<0.05);2组患者各时间点PaO2/FiO2、PIP、Pplat指标比较,差异无统计学意义(P>0.05);观察组各时间点HR、MAP比较,差异无统计学意义(P>0.05),对照组各时间点HR、MAP比较,差异有统计学意义(P<0.05);观察组治疗24、72 h后HR、MAP均低于对照组,差异有统计学意义(P<0.05)。结论:重度肺外源性急性呼吸窘迫综合征患者应用控制性膨胀肺复张与压力性控制肺复张均可改善血气指标与呼吸力学指标,但前者血流动力学更平稳,安全性更高。

Objective:To analyze the effect of different recruitment maneuvers on patients with severe extrapulmonary acute respiratory distress syndrome so as to provide reference for clinical treatment.Methods:Clinical data of 78 patients with severe extrapulmonary acute respiratory distress syndrome admitted to a hospital were retrospectively collected and were divided into a control group(n=37)and an observation group(n=41)according to recruitment maneuvers adopted.The observation group underwent sustained inflation recruitment maneuver and the control group adopted pressure control recruitment maneuver.Blood gas indexes,respiratory mechanical indexes and hemodynamic indexes were compared between the two groups.Results:24h and 72h after the treatment,PaO2/FiO2 in the two groups gradually increased compared with that before the treatment,and PIP and Pplat gradually decreased compared with those before the treatment(P<0.05).There was no significant difference in terms of PaO2/FiO2,PIP and Pplat between the two groups at each time point(P>0.05).There was no significant difference in HR and MAP in the observation group at each time point(P>0.05),but the difference was statistically significant in the control group(P<0.05).24h and 72h after the treatment,HR and MAP in the observation group were lower than those in the control group(P<0.05).Conclusion:Sustained inflation recruitment maneuver and pressure control recruitment maneuver in treatment of patients with severe extrapulmonary acute respiratory distress syndrome can improve blood gas indexes and respiratory mechanical indexes,but the former has more stable hemodynamics and higher safety.