气道压力释放通气联合俯卧位通气对中重度急性呼吸窘迫综合征患者呼吸功能及预后有改善作用

Improvement effect of airway pressure release ventilation combined with prone position ventilation on respiratory function and prognosis in patients with moderate to severe acute respiratory distress syndrome

目的:分析气道压力释放通气(APRV)联合俯卧位通气对中重度急性呼吸窘迫综合征(ARDS)患者呼吸功能及预后的改善作用。方法:回顾性分析56例中重度ARDS患者临床病历资料,均采用APRV联合俯卧位通气治疗。记录患者治疗前和治疗12、24、48、72 h后的动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、气道平均压(Pmean)、气道峰压(Ppeak)、肺动态顺应性(Cydn)、氧合指数(PaO_(2)/FiO_(2))、肺泡动脉氧分压差(P_(A-a)DO_(2))的改变;统计患者的28 d病死率、机械通气时间、入住ICU住院时间及不良事件的发生情况。结果:随着治疗时间的增加,PaCO_(2)、Pmean、Ppeak、P_(A-a)DO_(2)水平整体呈下降趋势,而PaO_(2)、Cydn、PaO_(2)/FiO_(2)水平呈升高趋势(P均<0.05);治疗72 h后,患者PaO_(2)、Ppeak、Cydn、P_(A-a)DO_(2)、PaO_(2)/FiO_(2)水平趋于稳定状态。患者28 d病死率为25.00%,机械通气时间(9.87±2.01)d,重症肺炎与脓毒症患者病死率较高;入住ICU时间(11.36±3.65)d,不良反应发生率为8.93%。结论:APRV联合俯卧位通气治疗重度ARDS效果较明显,可改善患者通气状态及氧合指数,有效避免肺损伤,对改善患者预后有效。

Objective:To analyze the effect of airway pressure release ventilation(APRV)combined with prone position ventilation on respiratory function and prognosis in patients with moderate to severe acute respiratory distress syndrome(ARDS).Methods:The clinical data of 56 patients with moderate to severe ARDS were retrospectively analyzed,and APRV combined with prone position ventilation was used for treatment.All of them were treated with APRV combined with prone ventilation.The arterial blood oxygen partial pressure(PaO_(2)),carbon dioxide partial pressure(PaCO_(2)),mean airway pressure(Pmean),peak airway pressure(Ppeak),and lung compliance(Cydn)were recorded after treatment for 12,24,48 and 72 h.Oxygenation index(PaO_(2)/FiO_(2))and changes in alveolar arterial partial pressure of oxygen(PA-_(a)DO_(2))were measured.The 28-day mortality rate,mechanical ventilation time,ICU stay in ICU and the occurrence of adverse events were analyzed.Results:As the treatment time increased,the levels of PaCO_(2),Pmean,Ppeak,and PA-_(a)DO_(2)showed an overall downward trend,while the levels of PaO_(2),Cydn,PaO_(2)/FiO_(2)showed an upward trend,and the difference was statistically significant(P<0.05).After treatment for 72 h,PaO_(2),Ppeak,Cydn,and PA-_(a)DO_(2)levels in patients tended to be stable.The 28-day fatality rate was 25.00%and the mechanical ventilation time was(9.87±2.01)days.Patients with severe pneumonia and sepsis had a higher mortality rate,the mechanical ventilation time was(11.36±3.65)days,and the adverse reaction rate was 8.93%.Conclusion:APRV combined with prone position ventilation is effective in the treatment of severe ARDS,which can improve the patient's ventilation status and oxygenation index,effectively avoid lung injury,and has a certain effect in improving the prognosis of patients.