ARDS患者镇痛镇静状态下呼吸力学改变的研究

目的探讨镇痛镇静对急性呼吸窘迫综合征（ARDS）患者呼吸力学改变。方法选择2011年4月—2013年4月期间入住本院重症医学科（ICU）确诊为ARDS需要机械通气患者51例,随机分为：常规机械通气组（A组27例）,镇痛镇静组（B组24例）,B组在A组基础上给予镇痛镇静治疗,比较2组患者治疗前后气道平台压（Pplat）、肺顺应性（Cst）、计算比较2组患者氧合指数（PaO2/FiO2）。结果 2组患者治疗前气道平台压（Pplat）、肺顺应性（Cst）、氧合指数（PaO2/FiO2）差异无统计学意义。治疗后2组患者气道平台压（Pplat）均呈明显下降趋势,24、48 h同时间点比较B组低于A组（t=2.225,P〈0.05;t=4.366,P〈0.01）;肺顺应性（Cst）在治疗后呈明显上升趋势,24、48 h比较B组高于A组（t=2.546,P〈0.05;t=3.152,P〈0.01）;治疗后2组患者PaO2/FiO2均呈上升趋势,24、48 h B组高于A组（t=2.744,P〈0.01;t=3.563,P〈0.01）。结论镇痛镇静对ARDS患者呼吸力学有正影响,改善肺氧合功能及顺应性,保护肺功能。

Effect of analgesia and sedation on parameters of respiratory mechanics in patients with acute respiratory distress syndrome

Objective To evaluate the effects of analgesia and sedation therapy on respiratory mechanics in patients with acute respiratory distress syndrome during mechanical ventilation. Methods 51 patients with ARDS were assigned randomly to one of the following two groups：1control group;2analgesia and sedation group. The control group was treated with low tidal volume ventilation and antispasmodic therapy and anti-infection treatment and symptomatic and supportive treatment. In addition to above treatment,the second group were given analgesia and sedation therapy. After the 51 patients treated for 24 or 48 h,the variation of airway plateau pressure（Pplat） and lung compliance（ Cst） and oxygenation index（PaO2/FiO2） of them were assessed. Results There was no statistical difference in Pplat and Cst and PaO2/FiO2 before treatment between the two groups. After the treatment,Pplat reduced significantly in both groups,and especially lower in group B at 24 h and 48 h time points（t = 2. 225,P〈0. 05;t = 4. 366,P〈0. 01）;while Cst elevated in both groups,and especially higher in group B at 24 h and 48 h time points（ t = 2. 546,P〈0. 05;t = 3. 152,P〈0. 01）;PaO2/FiO2 increased also in both groups,and especially in Group B（t = 2. 744,P〈0. 01;t = 3. 563,P〈0. 01）. Conclusion In conclusion,these studies showed that in ARDS patients the analgesia and sedation therapy may provide favorable clinical effects such as the decrease of airway plateau pressure and the increase of lung compliance and oxygenation index.