肺保护性通气序贯肺复张策略对外源性ARDS患者氧合功能及血流动力学的影响

Effect of Sequential Lung Recruitment Strategy with Lung Protective Ventilation for Oxygenation Function and Hemodynamics of Patients with Exogenous ARDS

目的探讨肺保护性通气序贯肺复张(RMB)策略对外源性急性呼吸窘迫综合征(ARDS)患者氧合功能及血流动力学的影响。方法随机选取本院2020年2月—2023年2月接诊的外源性ARDS患者70例作为研究对象,按照随机数字法分为治疗组和对照组,每组35例。其中,对照组采用肺保护性通气模式的常规治疗,即小潮气量(6mL/kg)+最佳呼气末正压(PEEP)的通气模式,治疗组在对照组的基础上增加RMB模式。观察两组患者临床治疗疗效、动脉血气分析指标以及血流动力学指标。结果治疗后,治疗组机械通气时间与住ICU时间比对照组明显短,且VAP发生率与病死率明显降低,组间差异有统计学意义(P<0.05);治疗组氧分压(PO2)、二氧化碳分压(PCO_(2))、氧合指数(FiO_(2))均明显高于对照组,组间差异有统计学意义(P<0.05);治疗组患者平均动脉血压(MAP)、中心静脉压(CVP)高于对照组,组间差异有统计学意义(P<0.05)。结论采用肺保护性通气序贯RMB策略可有效改善氧合功能,减轻对血清动力学影响,具有较高的应用价值。

Objective To explore effect of sequential lung recruitment(RMB)strategy with pulmonary protective ventilation on oxygenation function and hemodynamics of patients with exogenous acute respiratory distress syndrome(ARDS).Methods The paper chose 70 patients with exogenous ARDS in our hospital from February 2020 to February 2023 as research subjects,and divided them into two groups with random number method,35 cases in each group.Control group was treated with routine treatment with pulmonary protective ventilation mode,combination of low tidal volume(6ml/kg)and optimal positive end expiratory pressure(PEEP),and treatment group with RMB mode on the basis of control group.Clinical treatment effect,arterial blood gas analysis indicators,and hemodynamic blood indicators were observed between two groups.Results After treatment,mechanical ventilation time and ICU stay in treatment group was significantly shorter than control group,incidence and mortality of VAP was significantly lower,(P<0.05).The partial pressure of oxygen(PO2),partial pressure of carbon dioxide(PCO_(2)),and oxygenation index(FiO_(2))in treatment group was significantly higher than control group(P<0.05).The average arterial blood pressure(MAP)and central venous pressure(CVP)in treatment group was higher than control group(P<0.05).Conclusion Sequential RMB strategy of lung protective ventilation can improve oxygenation function and reduce effect on serum dynamics effectively,with high application value.