体外肋膈辅助技术在急性呼吸窘迫综合征患者机械通气中的应用

Application of in-vitro costal diaphragmatic auxiliary technique in acute respiratory distress syndrome patients with mechanical ventilation

目的探讨体外肋膈辅助技术在矫正机械通气患者急性呼吸窘迫综合征(acute respiration distress syndrome,ARDS)中的应用效果。方法将皖南医学院第一附属医院重症医学科(ICU)2020年3月至2021年1月收治的63例ARDS患者作为研究对象,按照随机数字表法分为试验组和对照组。对照组患者采取常规机械通气的支持治疗,试验组采用体外肋膈辅助技术联合机械通气进行治疗,两组均治疗至撤机拔管,治疗完毕后对患者进行28 d的随访。比较试验组患者治疗前、治疗30 min后的动脉血气血液酸碱度(p H)、动脉氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))、血乳酸(Lac)、氧合指数(PaO_(2)/FiO_(2)),潮气量(VT)、呼吸频率(f)、每分钟通气量(MV)、呼吸浅快指数(f/VT)、辅助肌肉疲劳度评分、心率(HR)、血氧饱和度(SpO_(2))、吸气峰流速(PIF)、呼气峰流速(PEF);比较两组患者机械通气时间、ICU住院时间、总住院时间、48 h再插管率、再入ICU率、28 d生存率、住院费用。结果体外肋膈辅助技术组患者治疗30 min后PaO_(2)、PaO_(2)/FiO_(2)、PaCO_(2)、VT、SpO_(2)、f、f/VT、辅助肌肉疲劳度评分、HR、PIF、PEF的改善优于治疗前(P<0.05);体外肋膈辅助技术组机械通气时间[10(4,16)d vs.13(11,22)d,P=0.04]、再入ICU率(0 vs.25%,P=0.003)低于常规治疗组(P<0.05)。结论体外肋膈辅助技术有助于改善ARDS患者的PaO_(2)、PaO_(2)/FiO_(2)、VT、PaCO_(2)、SpO_(2),降低患者的f、HR、PIF、PEF,解除患者的呼吸窘迫状态,减少机械通气时间,降低ICU的再转入率,促进患者的康复。

Objective To investigate the effect of in-vitro costal diaphragmatic auxiliary technology in the correction of acute respiratory distress syndrome(ARDS)patients with mechanical ventilation.Methods A total of 63 patients with ARDS admitted to the department of Critical Care Medicine of our hospital from March 2020 to January 2021 were selected as the study subjects,and were divided into the experimental group and the control group according to random number table method.The patients in the control group received conventional mechanical ventilation support treatment,and the patients in the experimental group received in-vitro costal diaphragmatic auxiliary technology combined with mechanical ventilation treatment.Both groups were treated until weaning extubation,and the patients were followed up for 28 days after treatment.Blood p H(p H),arterial oxygen partial pressure(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),lactic acid(Lac),oxygenation index(PaO_(2)/FiO_(2)),tidal volume(VT)and respiratory rate(f),minute ventilation volume(MV),shallow rapid respiratory index(f/VT),auxiliary muscle fatigue score,heart rate(HR),blood oxygen saturation(SpO_(2)),peak inspiratory flow rate(PIF),peak expiratory flow rate(PEF)of the patients in the experimental group were compared before treatment and 30 min after treatment;The duration of mechanical ventilation,length of stay in ICU,total length of stay,48-hour reintubation rate,ICU re-transfer rate,28-day survival rate and hospitalization cost were compared between the two groups.Results After 30 min treatment,the improvement of PaO_(2),PaO_(2)/FiO_(2),PaCO_(2),VT,SpO_(2),f,f/VT,auxiliary muscle fatigue score,HR,PIF and PEF were better than those before intervention in the experimental group(P<0.05).Mechanical ventilation time[10(4-16)d vs.13(11-22)d,P=0.04]and ICU re-transfer rate(0 vs.25%,P=0.003)in the experimental group were lower than those in the control group(P<0.05).Conclusions In-vitro costal diaphragmatic auxiliary technology can improve the levels of PaO_(2),PaO_(2)/FiO_(2),PaCO_(2),VT and SpO_(2)in the patients,reduce the respiratory rate,HR,PIF and PEF,relieve respiratory distress,reduce the duration of mechanical ventilation and the ICU re-transfer rate,and promote the recovery of the patients.