PICCO指导下的肺水管理在SAP所致ARDS序贯机械通气中的应用研究

目的 探讨脉波轮廓温度稀释连续心排血量监测技术(PICCO)指导下的肺水管理在无创-有创-无创序贯机械通气对重症急性胰腺炎(SAP)所致急性呼吸窘迫综合征(ARDS)的疗效.方法 选取2012年1月至2015年1月该院重症医学科由SAP所致ARDS患者,根据肺水管理的方式不同将所有研究对象分为治疗组(在PICCO指导下的肺水管理),对照组(无PICCO指导的肺水管理).比较两组无创通气时间、有创通气时间、总机械通气时间、病死率、肺水肿发生率、呼吸机相关性肺炎(VAP)发生率、入住ICU时间.结果 治疗组有创通气时间为(3.54±1.78)d低于对照组的(4.31士2.42)d(P＜0.05),肺水肿发生率为13.64％低于对照组的35.42％,VAP发生率为6.82％低于对照组的22.92％,病死率为11.36％低于对照的组29.17％,ICU住院时间为(7.21士1.13)d低于对照组的(8.19士1.28)d,差异均有统计学意义(P＜0.05).结论 SAP所致ARDS序贯机械通气在PICCO指导下的肺水管理更加精准有效,与其精确液体管理有关,有助于患者的救治,值得推广应用.

Research on application of lung water management guided by PICCO in SAP caused ARDS sequential mechanical ventilation

Objective To explore the effect of lung water management guided by pulse indicator continuous cardiac output (PICCO) in noninvasive-invasive-noninvasive sequential mechanical ventilation to severe acute pancreatitis (SAP) caused acute respiratory distress syndrome (ARDS).Methods The patients with ARDS caused by SAP in the department of critical care medicine in this hospital from January 2012 to January 2015 were selected as the research subjects and divided into the treatment group (lung water management guided by PICCO) and control group(without lung water management guided by PIC CO) according to different lung water management modes.The noninvasive ventilation time,invasive ventilation time,total mechanical ventilation time,mortality rate,incidence rate of pulmonary edema,incidence rate of ventilator associated pneumonia (VAP) and ICU stay time were compared between the two groups.Results The invasive ventilation time in the treatment group was (3.54 ± 1.78)d,which was lower than (4.31 ±2.42)d in the control group(P＜0.05);the occurrence rate of pulmonary edema in the treatment group was 13.64 ％,which was lower than 35.42％ in the control group;the VAP occurrence rate in the treatment group was 6.82 ％,which was lower than 22.92％ in the control group;the mortality rate was 11.36％,which was lower than 29.17％ in the control group;the ICU stay time was (7.21 ± 1.13)d,which was lower than (8.19 ± 1.28)d in the control group,the differences were statistically significant(P＜0.05).Conclusion The lung water management guided by PICCO in SAP caused ARDS sequential mechanical ventilation is more accurate and effective,which is related to accurate liquid management,conduces to the patient's treatment,and is worthy of popularization and application.