西维来司他钠联合气道压力释放通气治疗创伤所致重度ARDS的临床疗效观察

Observation of the Clinical efficacy of Sevoflurane Combined with Airway Pressure Release Ventilation in the Treatment of Severe ARDS Caused by Trauma

目的探讨西维来司他钠、气道压力释放通气治疗由创伤导致重度急性呼吸窘迫综合征(ARDS)的疗效。方法选取南阳市中心医院2020年1月至2022年12月期间收治80例重度ARDS患者,依照随机抽签的方法分成两组,各40例。对照组应用气道压力释放通气治疗,观察组在此基础上加用西维来司他钠,比较两组血气、炎性因子、血流动力学指标和预后。结果治疗前,两组动脉二氧化碳分压(PaCO_(2))、动脉氧分压(PaO_(2))、PaO_(2)/吸入氧浓度(FiO_(2))值比较,差异无统计学意义(P>0.05);治疗24 h、治疗72 h后,两组PaCO_(2)值均低于治疗前,PaO_(2)、PaO_(2)/FiO_(2)值均高于治疗前,且观察组PaCO_(2)值低于对照组,观察组PaO_(2)、PaO_(2)/FiO_(2)值高于对照组,差异有统计学意义(P<0.05)。治疗前,两组白细胞介素-6(IL-6)、降钙素原(PCT)、C反应蛋白(CRP)值比较,差异无统计学意义(P>0.05);治疗后,两组IL-6、PCT、CRP值均低于治疗前,且观察组IL-6、PCT、CRP值均低于对照组,差异有统计学意义(P<0.05)。治疗前,两组中心静脉压(CVP)、心率(HR)、平均动脉压(MAP)值比较,差异无统计学意义(P>0.05);治疗24 h、治疗72 h后,对照组CVP、HR、MAP值均低于治疗前,观察组HR低于治疗前,MAP治疗24 h低于治疗前,差异有统计学意义(P<0.05);治疗24 h、治疗72 h后,观察组CVP、HR、MAP值均高于对照组,差异有统计学意义(P<0.05)。治疗前,两组急性生理和慢性健康状况(APACHEⅡ)评分比较,差异无统计学意义(P>0.05);治疗后,两组APACHEⅡ评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论西维来司他钠、气道压力释放通气治疗创伤所致重度ARDS成效佳,能改善血气、炎性因子及血流动力学指标,提高预后。

Objective To explore the efficacy of sevoflurane and airway pressure release ventilation in the treatment of severe acute respiratory distress syndrome(ARDS)caused by trauma.Methods A total of 80 patients with severe ARDS were selected from Nanyang Central Hospital between January 2020 to December 2022.According to random number table,patients were divided into control group(n=40)and observation group(n=40).The control group received airway pressure release ventilation treatment,while the observation group received additional treatment with sivelestat sodium.The blood gas,inflammatory factors,hemodynamic indicators,and prognosis were compared between the two groups.Results Before treatment,there were no statistically significant difference in partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),and PaO/fraction of inspired oxygen(FiO_(2))values between the two groups(P>0.05).After 24 hours and 72 hours of treatment,the PaCO_(2) values in both groups were lower than before treatment,while the PaO_(2) and PaO_(2)/FiO_(2) values were higher than before treatment.The PaCO_(2) value in the observation group was lower than that in the control group,and the PaO_(2) and PaO_(2)/FiO_(2) values in the observation group were higher than those in the control group,indicating statistically significant differences(P<0.05).Before treatment,there were no statistically significant differences in interleukin-6(IL-6),procalcitonin(PCT),and C-reactive protein(CRP)values between the two groups(P>0.05).After treatment,the IL-6,PCT,and CRP values in both groups were lower than before treatment,and the IL-6,PCT,and CRP values in the observation group were lower than those in the control group,indicating statistically significant differences(P<0.05).Before treatment,there were no statistically significant differences in central venous pressure(CVP),heart rate(HR),and mean arterial pressure(MAP)values between the two groups(P>0.05).After 24 hours and 72 hours of treatment,the CVP,HR,and MAP values in the control group were lower than before treatment,while the HR value in the observation group was lower than before treatment,and the MAP value at 24 hours after treatment was lower than before treatment,indicating statistically significant differences(P<0.05).After 24 hours and 72 hours of treatment,the CVP,HR,and MAP values in the observation group were higher than those in the control group,indicating statistically significant differences(P<0.05).Before treatment,there were no statistically significant differences in acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)scores between the two groups(P>0.05).After treatment,the APACHEⅡ scores in both groups were lower than before treatment,and the observation group had a lower score than the control group,indicating statistically significant differences(P<0.05).Conclusion Sivelestat sodium and airway pressure release ventilation can reduce the inflammatory factors,improve the blood gas analysis indicators,treatment effects and prognosis for trauma-induced severe acute respiratory distress syndrome patients.