俯卧位通气在急性呼吸窘迫综合征患者中的应用研究

Study on the Application of Prone Position Ventilation in Patients with Acute Respiratory Distress Syndrome

目的探讨俯卧位通气在急性呼吸窘迫综合征患者中的临床应用价值。方法选择2020年5月—2021年4月日照市中医医院收治的急性呼吸窘迫综合征患者80例为研究对象。按照随机数表法分为两组,各40例。对照组所有治疗过程中均保持患者为仰卧位与侧卧位,观察组则实施俯卧位通气,比较两组血气分析结果、炎症因子、氧合指数水平、血流动力学相关异常情况、干预期间并发症发生率及呼吸干预治疗时间。结果观察组发生低氧血症、二氧化碳蓄积的比例分别为37.5%、5.0%,均明显低于对照组,差异有统计学意义(χ^(2)=19.013、7.440,P<0.05),但两组过度通气比例比较,差异无统计学意义(P>0.05)。干预后,观察组hs-CRP为(11.7±3.5)mg/L,低于对照组,氧合指数为(348.9±78.9)mmHg,高于对照组,差异有统计学意义(t=3.782、6.187,P<0.05)。两组血流动力学相关异常(低中心静脉压、低血压、低心排血量和心动过速)总发生率均为25.0%,差异无统计学意义(P>0.05)。观察组并发症(气胸、脓毒血症、颅内出血和压力性损伤)发生率为5.0%,显著低于对照组的25.0%,差异有统计学意义(χ^(2)=6.275,P<0.05)。观察组有创呼吸机治疗时间为(3.8±1.4)d、无创呼吸机治疗时间为(5.5±2.3)d、总用氧治疗时间为(12.7±6.6)d,均显著短于对照组,差异有统计学意义(t=4.260、2.247、2.360,P<0.05)。结论对急性呼吸窘迫综合征患者实施俯卧位通气,可有效改善机体氧合,降低炎症反应,对血流动力学影响小,缩短用氧治疗时间。

Objective To explore the clinical application value of prone ventilation in patients with acute respiratory distress syndrome.Methods 80 patients with acute respiratory distress syndrome admitted to Rizhao Hospital of Traditional Chinese Medicine from May 2020 to April 2021 were selected as the study objects.According to the random number table method,they were divided into two groups,40 cases each.Patients in the control group were kept in supine and lateral positions during all treatments,while patients in the observation group were ventilated in prone position.Blood gas analysis results,inflammatory factors,oxygenation index levels,hemodynamic related abnormalities,incidence of complications during intervention and duration of respiratory intervention were compared between the two groups.Results The proportion of hypoxemia CO2 accumulation observation group were 37.5%,5.0%,respectively,significantly lower than those in the control group,the difference was statistically significant(χ^(2)=19.013,7.440,P<0.05),but excessive air ratio in two groups were compared,the difference was not statistically significant(P>0.05).After intervention,hs-CRP in the observation group was(11.7±3.5)mg/L,lower than that in the control group,and oxygenation index(348.9±78.9)mmHg was higher than that in the control group,the difference was statistically significant(t=3.782,6.187,P<0.05).The total incidence of hemodynamic related abnormalities(low central venous pressure,hypotension,low cardiac output and tachycardia)was 25.0%in both groups,the difference was not statistically significant(P>0.05).The complications(pneumothorax,sepsis,intracranial hemorrhage,and pressure in jury)incidence was 5.0%in observation group,significantly less than 25.0%of the control group,the difference was statistically significant(χ^(2)=6.765,P<0.05).The invasive ventilator treatment time of(3.8±1.4)d,non-invasive ventilator treatment time of(5.5±2.3)d and total oxygen treatment time of(12.7±6.6)d in the observation group were significantly shorter than those in the control group,and the difference was statistically significant(t=4.260,2.247,2.360,P<0.05).Conclusion Prone ventilation in patients with acute respiratory distress syndrome can effectively improve body oxygenation,reduce inflammatory response,have little effect on hemodynamics,and shorten the time of oxygen therapy.