肺保护性通气序贯肺复张在胸部外伤并发ARDS患者中的应用效果分析

Analysis on the Application Effect of Lung Protective ventilation Sequentially Combined with Lung Recruitment Maneuvers in Patients with Thoracic Trauma and ARDS

目的分析探讨肺保护性通气序贯肺复张对胸部外伤并发急性呼吸窘迫综合征(ARDS)的临床疗效。方法选取2017年6月至2019年12月新乡医学院第三附属医院收治的75例胸部外伤并发ARDS患者作为研究对象,并按照随机数表法将其随机分为研究组(38例)与对照组(37例),研究组患者采用肺保护性通气序贯肺复张治疗,对照组患者单纯采用肺保护性通气治疗,对比观察两组患者氧分压(PO_(2))、氧饱和度(SO_(2))、pH值、血浆二氧化碳总量(TCO_(2))、二氧化碳分压(PCO_(2))、氧合指数(PaO_(2)/FiO_(2))以及机械通气时间、呼吸机相关性肺炎(VAP)发生率和28 d病死率。结果治疗24、48、72 h时,研究组患者PO_(2)、SO_(2)、pH值、TCO_(2)、PCO_(2)、PaO_(2)/FiO_(2)均明显高于对照组(PO_(2):t=4.440、4.594、3.571,P均<0.001;SO_(2):t=2.271、2.355、2.062,P=0.026、0.021、0.043;pH值:t=2.445、2.873、2.107,P=0.017、0.005、0.039;TCO_(2):t=4.039、5.765、4.803,P均<0.001;PCO_(2):t=2.450、2.257、3.077,P=0.017、0.027、0.003;PaO_(2)/FiO_(2):t=7.453、7.742、9.671,P均<0.001);研究组患者机械通气时间明显短于对照组(t=6.905,P<0.001),VAP发生率明显低于对照组(χ^(2)=4.789,P=0.029),28 d病死率与对照组无明显差异(χ^(2)=1.314,P=0.252)。结论肺保护性通气序贯肺复张可显著改善胸部外伤并发ARDS患者的氧合状态,缩短机械通气时间,降低VAP发生率,临床应用价值较高。

Objective To analyze the clinical efficacy of lung protective ventilation sequentially combined with lung recruitment maneuvers on patients with thoracic trauma complicated with acute respiratory distress syndrome(ARDS).Methods Seventy-five patients with thoracic trauma and ARDS,admitted to The Third Affiliated Hospital of Xinxiang Medical University from June 2017 to December 2019,were selected as research subjects and divided,according to the random number table,into a study group(38 cases)and a control group(37 cases).Patients in the study group were treated with lung protective ventilation combined with lung recruitment maneuvers sequentially,while patients in the control group were treated with lung protective ventilation only.The partial pressure of oxygen(PO_(2)),saturation of oxygen(SO_(2)),pH value,total plasma carbon dioxide(TCO_(2)),partial pressure of carbon dioxide(PCO_(2)),oxygenation index(PaO_(2)/FiO_(2))and mechanical ventilation time,incidence of ventilator-associated pneumonia(VAP)and 28-day fatality rate were compared between the two groups.Results At 24 h,48 h and 72 h of treatment,the levels of PO_(2),SO_(2),pH,TCO_(2),PCO_(2),and PaO_(2)/FiO_(2) in the study group were all significantly higher than that in the control group(PO_(2):t=4.440,4.594,3.571,all P<0.001;SO_(2):t=2.271,2.355,2.062,P=0.026,0.021,0.043;pH:t=2.445,2.873,2.107,P=0.017,0.005,0.039;TCO_(2):t=4.039,5.765,4.803,all P<0.001;PCO_(2):t=2.450,2.257,3.077,P=0.017,0.027,0.003;PaO_(2)/FiO_(2):t=7.453,7.742,9.671,all P<0.001).Moreover,the mechanical ventilation time in the study group was significantly shorter than that in the control group(t=6.905,P<0.001)and the incidence of VAP was significantly lower than that in the control group(χ^(2)=4.789,P=0.029).However,there was no significantly difference in the 28-day fatality rate between the two groups(χ^(2)=1·314,P=0.252).Conclusion The treatment protocol of lung protective ventilation sequentially combined with lung recruitment maneuvers can significantly improve the oxygenation status of patients with thoracic trauma complicated with ARDS,shorten mechanical ventilation time and reduce the incidence of VAP,presenting a high value of clinical application.