早期俯卧位机械通气在重度ARDS临床治疗中的应用价值分析

Application Value of Early Prone Mechanical Ventilation in the Clinical Treatment of Severe ARDS

目的 研究早期俯卧位通气在重度急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)临床治疗中的应用价值。方法 选择重庆市江津区第二人民医院在2019年1月—2021年1月期间收治的100例重度ARDS患者(氧合指数≤150 mmHg)作为本次研究的对象,然后按照随机数表法进行分组,分成对照组和观察组,各50例。对照组患者通过常规体位机械通气治疗,观察组患者通过早期俯卧位机械通气治疗,比较两组患者的血氧饱和度、血氧分压、平均动脉压、二氧化碳分压;APACHEⅡ评分;带管时间、ICU治疗时间、呼吸机治疗时间;28 d存活率、90 d存活率、病死率。结果 治疗前,两组患者的血氧饱和度、血氧分压、平均动脉压、二氧化碳分压水平比较,差异无统计学意义(P>0.05);治疗后,观察组患者的血氧饱和度、血氧分压、平均动脉压、二氧化碳分压水平均优于对照组患者,差异有统计学意义(P<0.05)。治疗前,两组患者APACHEⅡ评分比较,差异无统计学意义(P>0.05);治疗后,观察组患者的APACHEⅡ评分(12.55±3.19)分均低于对照组患者(18.46±3.52)分,差异有统计学意义(t=8.797,P<0.05)。观察组患者的带管时间、ICU治疗时间、呼吸机治疗时间均少于对照组患者,差异有统计学意义(P<0.05)。观察组患者的28 d存活率、90 d存活率、病死率和对照组比较,差异无统计学意义(P>0.05)。结论 重度ARDS患者通过早期俯卧位机械通气治疗,能够有效提升临床疗效,改善患者的生命体征,病死率较低,应用价值高,值得推广。

Objective To study the application value of early prone position ventilation in the clinical treatment of severe acute respiratory distress syndrome(ARDS).Methods A total of 100 severe ARDS patients(oxygenation index ≤150 mmHg) admitted to the Second People’s Hospital of Jiangjin District, Chongqing between January 2019 and January 2021 were selected as the subjects of this study. According to the random number table method, the selected subjects were divided into control group and observation group, each group was 50 patients. The patients in the control group were treated with conventional mechanical ventilation, while the patients in the observation group were treated with mechanical ventilation in the early prone position. Blood oxygen saturation, blood oxygen partial pressure, mean arterial pressure, carbon dioxide partial pressure;APACHE II score;intubation time, ICU treatment time, ventilator treatment time;28-day survival rate, 90-day survival rate, and case fatality rate were compared between the two groups.Results Before treatment, there was no statistically significant difference in the levels of blood oxygen saturation, blood oxygen partial pressure, mean arterial pressure and carbon dioxide partial pressure between the two groups(P>0.05). After treatment, the levels of blood oxygen saturation, blood oxygen partial pressure, mean arterial pressure and carbon dioxide partial pressure in the observation group were better than those in the control group, and the difference was statistically significant(P<0.05). Before treatment, there was no statistically significant difference in APACHE II score between the two groups(P>0.05). After treatment, the APACHE II scores of the observation group(12.55±3.19) points were lower than those of the control group(18.46±3.52) points, and the difference was statistically significant(t=8.797, P<0.05). The intubation time, ICU treatment time, and ventilator treatment time of the observation group were shorter than those of the control group, and the differences were statistically significant(P<0.05).There was no statistically significant difference in the 28-day survival rate, 90-day survival rate, and case fatality rate between the observation group and the control group(P>0.05).Conclusion Early prone mechanical ventilation in patients with severe ARDS can effectively improve the clinical efficacy and improve the patient’s vital signs. The mortality rate is low, and the application value is high, which is worthy of promotion.