小潮气量肺保护通气对急性有机磷农药中毒伴呼吸衰竭患者血气分析指标、氧化应激水平的影响

The effect of small tidal volume pulmonary protective ventilation on the blood gas analysis and the level of oxidative stress in patients with acute organophosphorus pesticide poisoning with respiratory failure

目的分析小潮气量肺保护通气对急性有机磷农药中毒伴呼吸衰竭患者血气分析指标、氧化应激水平的影响。方法选择2016年4月—2019年2月本院收治的急性有机磷农药中毒伴呼吸衰竭患者60例作为研究对象,随机数表法分为对照组和观察组两组,每组各30例。两组患者均给予常规基础治疗,对照组加用常规机械通气治疗,观察组加用小潮气量肺保护通气治疗。比较两组患者治疗后的临床疗效。结果观察组自主呼吸恢复时间、意识恢复时间、住院时间短于对照组,阿托品用量少于对照组,差异均有统计学意义(P<0.05)。治疗前两组血气分析指标、氧化应激水平比较,差异均无统计学意义(P>0.05)。治疗后,观察组血氧分压(PaO_(2))、血氧饱和度(SaO_(2))及超氧化物歧化酶(SOD)、谷胱甘肽(GSH)水平高于对照组,血二氧化碳分压(PaCO_(2))、丙二醛(MDA)水平低于对照组,差异均具有统计学意义(P<0.05)。观察组治愈率(93.33%)高于对照组(73.33%),差异具有统计学意义(P<0.05)。结论小潮气量肺保护通气辅助治疗急性有机磷农药中毒伴呼吸衰竭可有效减轻氧化应激损伤,改善血气指标,提高治愈率。

Objective To analyze the effect of low tidal volume pulmonary protective ventilation on blood gas analysis and oxidative stress in patients with acute organophosphorus pesticide poisoning with respiratory failure.Methods Sixty patients with acute organophosphorus pesticide poisoning complicated with respiratory failure those treated in our hospital from April 2016 to February 2019 were divided into two groups including control group and observation group,30 cases in each group.Patients in both two groups were treated with routine treatment,and on this bases,the control group was treated with conventional mechanical ventilation and the observation group was treated with small tidal volume lung protection and ventilation.The clinical curative effects of the two groups after treatment were analyzed.Results In the observation group,the recovery time of spontaneous respiration,the recovery time of consciousness,and the hospitalization time were significantly shorter than those in the control group,and the dosage of atropine was significantly lower than that of control group(P<0.05).There was no significant difference in blood gas analysis index and oxidative stress level between the two groups before treatment(P>0.05).After treatment,the partial pressure of blood oxygen(PaO_(2)),oxyhemoglobin saturation(SaO_(2))and the levels of superoxide dismutase(SOD),glutathione S-transferase(GSH)in the observation group were higher than those in the control group,and the partial pressure of carbon dioxide(PaCO_(2))and malondialdehyde(MDA)in the observation group were lower than those of the control group(P<0.05).The cure rate of the observation group(93.33%)was higher than that of the control group(73.33%),the difference was statistically significant(P<0.05).Conclusions Pulmonary protective ventilation with low tidal volume could effectively reduce oxidative stress injury,improve blood gas index and improve cure rate in the treatment of acute organophosphorus pesticide poisoning with respiratory failure.