俯卧位通气联合气道压力释放通气模式在中重度急性呼吸窘迫综合征患者中的应用效果

The Application Effect of Prone Position Ventilation Combined with Airway Pressure Release Ventilation Mode in Patients with Moderate to Severe Acute Respiratory Distress Syndrome

目的探讨俯卧位通气联合气道压力释放通气(APRV)模式在中重度急性呼吸窘迫综合征(ARDS)患者中的应用效果。方法选取2020年6月至2022年6月医院收治的86例中重度ARDS患者为研究对象,采用随机数字表法分为对照组和试验组,每组43例。对照组在常规机械通气基础上给予俯卧位通气,试验组在对照组基础上给予APRV模式通气,比较两组氧合指标[包括动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))]、血流动力学指标[包括中心静脉压(CVP)、平均动脉压(MAP)、心率(HR)]及通气指标[包括平台压(P_(plat))、气道峰压(P_(peak))、气道平均压(P_(mean))、肺动态顺应性(C_(dyn))]。结果治疗3 d后,两组PaO_(2)、SaO_(2)均高于治疗前,PaCO_(2)低于治疗前,且试验组PaO_(2)、SaO_(2)均高于对照组,PaCO_(2)低于对照组,差异均有统计学意义(P<0.05);两组CVP、HR均低于治疗前,MAP均高于治疗前,且试验组CVP、HR低于对照组,MAP高于对照组,差异均有统计学意义(P<0.05);两组P_(plat)、P_(peak)均低于治疗前,P_(mean)、C_(dyn)均高于治疗前,且试验组P_(plat)、P_(peak)低于对照组,P_(mean)、C_(dyn)高于对照组,差异均有统计学意义(P<0.05)。结论俯卧位通气联合APRV模式在中重度ARDS患者中的应用效果显著,可有效改善患者的氧合指标、血流动力学指标及通气指标。

Objective The application effect of prone position ventilation combined with airway pressure release ventilation(APRV)mode in patients with moderate to severe acute respiratory distress syndrome(ARDS)was explored.Methods The 86 patients with moderate to severe ARDS admitted to the hospital from June 2020 to June 2022 were selected as the study subjects.They were randomly divided into the control group and the experimental group,by using the random number table method,with 43 patients in each group.The control group received prone position ventilation on the basis of conventional mechanical ventilation,while the experimental group received APRV mode ventilation on the basis of the control group.The oxygenation indexes[including arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),arterial oxygen saturation(SaO_(2))],hemodynamic indicators[including central venous pressure(CVP),mean arterial pressure(MAP),heart rate(HR)]and ventilation indicators[including plateau pressure(P_(plat)),peak airway pressure(P_(peak)),mean airway pressure(P_(mean)),and dynamic lung compliance(C_(dyn))]were compared between the two groups.Results After 3 days of treatment,PaO_(2) and SaO_(2) in both groups were higher than before treatment,PaCO_(2) was lower than before treatment,and PaO_(2) and SaO_(2) in the experimental group were higher than those in the control group,while PaCO_(2) was lower than those in the control group,with statistically significant differences(P<0.05);In both groups,CVP and HR were lower than before treatment,while MAP was higher than before treatment.Moreover,the experimental group had lower CVP and HR than the control group,while MAP was higher than the control group,with statistical significance(P<0.05);The Pplat and Ppeak levels in both groups were lower than before treatment,while the Pmean and Cdyn levels were higher than before treatment.Additionally,the Pplat and Ppeak levels in the experimental group were lower than those in the control group,while the Pmean and Cdyn levels were higher than those in the control group,with statistical significance(P<0.05).Conclusion The application of prone position ventilation combined with APRV mode in patients with moderate to severe ARDS has a significant effect,which can effectively improve the oxygenation,hemodynamic,and ventilation indicators of patients.