压力调节容量控制通气模式在ARDS病人机械通气治疗中的应用效果评价

Evaluation of the Efficacy of Pressure-Regulated Volume-Control Ventilation Mode in Mechanical Ventilation Therapy of ARDS Patients

目的:探讨压力调节容量控制通气在急性呼吸窘迫综合征机械通气治疗中的应用效果。方法:回顾性选取2019年2月至2022年2月江南大学附属医院中重度急性呼吸窘迫综合征患者120例,依据治疗方法分为压力调节容量控制通气组(观察组)、同步间歇指令通气组(对照组)两组,分别为56例,64例,统计分析两组患者机械通气后24h后的呼吸力学与血气指标、并对两组患者总体临床疗效、氧疗时间、机械通气时间、住院时间、并发症以及28d预后等进行对比性分析。结果:机械通气治疗后24h,与对照组相比观察组患者平均动脉压(MAP)(12.45vs14.56 KPa)、呼气末正压(PEEP)(9.42vs12.02 cmH_(2)O)、气道峰压(PIP)(25.42vs28.56 cmH_(2)O)、动脉血二氧化碳分压(PaCO_(2))(38.41vs47.47 mmHg)均明显低于对照组(P<0.05),动脉血氧分压(PaO_(2))(69.90vs65.00 mmHg)高于对照组(P<0.05)。治疗28d,观察组患者的治疗总有效率(92.85%)明显高于对照组(78.13%)(χ^(2)=5.084,P<0.05)。与对照组相比观察组患者的氧疗时间(158.08vs170.61h),机械通气时间(87.40vs125.30h),住院时间(15.51vs24.11 d)均显著低于对照组(P<0.05)。观察组患者的呼吸机相关性肺损伤发生率(7.14%vs39.06%)明显低于对照组(P<0.05)。结论:与同步间歇指令通气组相比,急性呼吸窘迫综合征治疗中压力调节容量控制通气治疗可显著改善患者呼吸力学和血气指标,提高临床疗效,缩短氧疗时间、机械通气时间和住院时间,降低呼吸机相关性肺损伤发生率,改善患者28d预后。

Objective:To explore the application effect of pressure-regulated volume control in the treatment of acute respiratory distress syndrome.Methods:From February 2019 to February 2022,120 patients with moderate-to-severe acute respiratory distress syndrome in the Affiliated Hospital of Jiangnan University were retrospectively selected and divided into two groups according to the treatment method:pressure-regulated volume-controlled ventilation group(observation group)and synchronous intermittent command ventilation group(control group),56 and 64 patients respectively.Respiratory mechanics and blood gas parameters after 24 hours of mechanical ventilation were statistically analysed and the overall clinical outcome,duration of oxygen therapy,duration of mechanical ventilation,length of hospital stay,complications and prognosis at 28 days were compared between the two groups.Results:24h after treatment,the mean arterial pressure(MAP)(12.45 vs 14.56 KPa),positive end-expiratory pressure(PEEP)(9.42vs12.02 cmH_(2)O),peak airway pressure(PIP)(25.42vs28.56 cmH_(2)O)and arterial carbon dioxide partial pressure(PaCO_(2))(38.41vs47.47 mmHg)in the observation group were significantly lower than those in the control group(P<0.05),the arterial partial pressure of oxygen(PaO_(2))(69.90vs65.00mmHg)was higher than that of the control group(P<0.05).28days after treatment,the total effective rate of patients in the observation group(92.85%)was significantly higher than that in the control group(78.13%)(χ2=5.084,P<0.05).Compared to the control group,in the observation group the oxygen therapy time(158.08vs170.61h)(P<0.05),the mechanical ventilation time(87.40vs125.30h)(P<0.05),and the hospitalization time(15.51vs24.11d)(P<0.05)were shorter.The incidence of ventilator-related lung injury in the observation group(7.14%)was significantly lower than that in the control group(39.06%)(P<0.05).Conclusion:Compared to the synchronised intermittent command ventilation group,pressure-regulated volume-controlled ventilation in the treatment of acute respiratory distress syndrome significantly improved patients'respiratory mechanics and blood gas indices,improved clinical outcomes,shortened oxygen therapy time,duration of mechanical ventilation and hospital stay,reduced the incidence of ventilator-associated lung injury and improved patients'28-day prognosis.