重度脑外伤术后并发ARDS治疗分析

目的探讨肺复张技术对重度颅脑外伤后并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的治疗效果。方法选取本院2008年1月至2013年9月收治的65例重度颅脑外伤术后并发ARDS的患者为研究对象,根据随机数字表将患者分为对照组32例及观察组33例,对照组给予常规机械通气治疗,观察组在对照组基础上行肺复张技术治疗,对比分析两组治疗前后血气指标、器官功能障碍评分(sepsis-related organ failure assessment,SOFA)、急性生理及慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、肺损伤评分(Murray评分)、格拉斯哥昏迷评分(Glasgow coma scale,GCS)的差异。结果观察组治疗后48hSOFA评分、APACHEⅡ评分、Murray评分显著低于治疗前及对照组治疗后,而GCS显著升高,差异有统计学意义(P0.05)。观察组治疗后氧合指数(PaO2/FiO2)显著高于对照组,差异有统计学意义(P0.05)。两组患者死亡率、机械通气时间无统计学差异(P0.05),但观察组入住ICU时间显著短于对照组,差异有统计学意义(P0.05)。观察组肺复张时,平均脉压(mean arterial pressure MAP),而心律(heart rate,HR)、中心静脉压(central venous pressure,CVP)上升,与复张前相比,差异有统计学意义(P0.05),而复张结束后120s MAP、HR、CVP逐渐恢复,与复张时相比差异显著(P0.05)。结论肺复张能有效改善氧合指数,改善患者预后,且血流动力学影响短暂,安全有效。

Treatment of ARDS after Severe Traumatic Brain Surgery

Objective To investigate the treatment of lung recruitment techniques for severe brain surgery with acute respiratory distress syndrome （ARDS）. Methods 65 patients of severe traumatic brain injury patients with postoperative ARDS were divided into control group （n = 32）and observation group （n = 33）from January 2008 to September 2013. The control group were treated with conventional mechanical ventilation. The observation group were treated with lung recruitment. The blood gas,organ dysfunction score （ SOFA）, acute physiology and chronic health evaluation 11 （APACHE ]]）, lung injury score （Murray score） and Glasgow coma scale（GCS） of two groups were compared. Results The SOFA, APACHE ]I , Murray score of observation group were lower than control group after treatment （P 〈0.05）. The GCS score of observation group were higer than control group after treatment （P 〈 0.05）. The arterial PaO2/FiO2 of observation group were higher than control group （P 〈 0.05）. The mortality and mechanical ventilation time of two groups were not significantly different （P 〉 0. 05）. The ICU time of observa- tion group were shorter than the control group （P 〈0. 05）. The mean pulse pressure （MAP） declined, while the heart rate （HR）, central venous pressure （CVP） of observation group were increased than before when the lung re- cnnted （P 〈 0.05）. Conclusion The lung recruitment can effectively improve the lung oxygenation index and promote prognosis with little influence of hemodynamics.