不同PEEP水平对ARDS机械通气患者预后的影响

Effect of different PEEP levels on the prognosis of mechanically ventilated patients with ARDS

目的观察急性呼吸窘迫综合征(ARDS)患者机械通气时应用不同水平呼气末正压(PEEP)对预后的影响,为ARDS患者的呼吸机参数选择提供参考依据。方法选取2019年11月至2020年11月华北理工大学附属医院重症医学科收治的80例ARDS患者为研究对象。按照随机数字表法将ARDS患者分为A、B、C、D四组,其中A组PEEP为5 cmH_(2)O、B组PEEP为10 cmH_(2)O、C组PEEP为15 cmH_(2)O、D组PEEP为20 cmH_(2)O,每组各20例。观察四组患者不同PEEP水平的呼吸功能指标(pH、PaCO_(2)、PaO_(2)、PaO_(2)/FiO_(2)),血流动力学指标(HR、MAP、CVP)变化,用SPSS 24.0软件做统计学分析。结果不同PEEP水平对pH、PaCO_(2)、MAP的影响,差异无统计学意义(P>0.05);PEEP为5 cmH_(2)O、10 cmH_(2)O、15 cmH_(2)O时,患者PaO_(2)、PaO_(2)/FiO_(2)随PEEP增加而升高,差异有统计学意义(P<0.01),HR、CVP随PEEP增加而增加,差异无统计学意义(P>0.05);PEEP为20 cmH_(2)O与15 cmH_(2)O比较,PaO_(2)、PaO_(2)/FiO_(2)增加,差异无统计学意义(P>0.05),HR、CVP升高,差异有统计学意义(P<0.05)。结论ARDS患者机械通气时选择PEEP水平为15 cmH_(2)O可改善患者呼吸功能,对循环功能影响较小。

Objective To observe the effect of applying different levels of positive end-expiratory pressure(PEEP)on the prognosis of patients with acute respiratory distress syndrome(ARDS)during mechanical ventilation,and to provide a reference for the selection of ventilator parameters in ARDS patients.Methods A total of 80 patients with ARDS admitted to the Intensive Care Unit of the Affiliated Hospital of North China University of Science and Technology from November 2019 to November 2020 were selected as the study objects.These ARDS patients were divided into group A,B,C and D according to the random number table method,with 20 patients in each group,where PEEP was 5 cmH_(2)O in group A,10 cmH_(2)O in group B,15 cmH_(2)O in group C and 20 cmH_(2)O in group D.The changes of respiratory function indices[potential of hydrogen(pH),partial pressure of carbon dioxide in artery(PaCO_(2)),partial pressure of oxygen(PaO_(2)),PaO_(2)/fraction of inspiration oxygen(FiO_(2))],hemodynamic indices[heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP)]in the four groups at different PEEP levels were observed,and statistical analysis was performed with the Statistical Product and Service Solutions(SPSS)24.0 software.Results There were no statistically significant differences in the impacts of different PEEP levels on pH,PaCO_(2) and MAP(P>0.05).Patients'PaO_(2) and PaO_(2)/FiO_(2) increased with the increase of PEEP when PEEP was 5 cmH_(2)O,10 cmH_(2)O and 15 cmH_(2)O,with statistically significant differences(P<0.01).Meanwhile,HR and CVP increased with the increase of PEEP,without statistically significant differences(P>0.05).Compared with 15 cmH_(2)O,PaO_(2),PaO_(2)/FiO_(2) increased with PEEP of 20 cmH_(2)O,without statistically significant differences(P>0.05),while HR and CVP increased,with statistically significant differences(P<0.05).Conclusion Selecting a PEEP level of 15 cmH_(2)O during mechanical ventilation in ARDS patients can improve patients'respiratory function and have less impact on circulatory function.