气道压力释放通气对中重度急性呼吸窘迫综合征临床疗效观察

目的探讨气道压力释放通气(APRV)对中重度急性呼吸窘迫综合征(ARDS)的临床疗效。方法选择海南省第二人民医院2013年6月至2016年6月接诊的60例中重度ARDS患者,通过随机数表法分为两组,气道压力释放通气组(APRV组)和小潮气量肺保护通气组,即使用容量同步间歇指令通气+呼气末正压(SIMV组),各30例。比较两组患者通气效果。结果通气后1、2、3 d,两组患者在气道峰压(Ppeak)、气道平均压(Pmean)、氧合指数(Pa O2/Fi O2)、血管外肺水指数(ELWI)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、Murray急性肺损伤评分均较通气前得到改善(P0.05);APRV组在通气后1、2 d时,Ppeak、Pmean、ELWI水平均比SIMV组低(P0.05),APRV组在通气后1、2、3 d时,Pa O2/Fi O2水平均比SIMV组高(P0.05),APRV组在通气后1、2、3 d时,HR、CVP水平均低于SIMV组,MAP水平均高于SIMV组(P0.05),APRV组通气后1、2、3 d时,Murray急性肺损伤评分均低于SIMV组(P0.05);APRV组无镇静剂使用时间、脱离呼吸机时间长于SIMV组,住ICU时间短于SIMV组(P0.05),两组在无脏器衰竭时间上无显著差异(P0.05);两组患者1个月内死亡率无显著差异(P0.05)。结论在中重度ARDS患者中使用APRV通气模式,可提高有效的呼吸支持,值得应用推广。

Clinical observation of airway pressure release ventilation in moderate and severe acute respiratory distress syndrome

Objective To explore the clinical effects of airway pressure release ventilation, (APRV) in moderate and severe acute respiratory distress syndrome(ARDS).Methods All 60 patients with moderate and severe ARDS from June 2013 to June 2016 in The Second People′s Hospital of Hainan Province were researched.They were divided into two groups by randomly, APRV group and tidal volume lung protection ventilation group, using volume synchronous intermittent mandatory ventilation and positive end expiratory pressure(SIMV group), each of 30 cases.The ventilation effect of two groups were compared.Results After ventilation 1 d, 2 d, 3 d, the peak airway pressure (Ppeak), mean airway pressure (Pmean), oxygenation index (PaO2/FiO2), extravascular lung water index (ELWI), heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Murray acute lung injury score of two groups were improved before ventilation(P<0.05);After ventilation 1 d, 2 d, in the APRV group, the levels of Ppeak, Pmean, ELWI were lower than the SIMV group(P<0.05), after ventilation 1 d, 2 d, 3 d, in the APRV group, the levels of PaO2/FiO2 was higher than the SIMV group(P<0.05), after ventilation 1 d, 2 d, 3 d, in the APRV group, the levels of HR, CVP were lower than the SIMV group, the levels of MAP was higher than the SIMV group(P<0.05), after ventilation 1 d, 2 d, 3 d, in the APRV group, the Murray acute lung injury score was lower than the SIMV group(P<0.05);the oo sedative time, weaning time of APRV group were longer than the SIMV group, the Live ICU time was shorter than the SIMV group(P<0.05), there was no significant difference between the two groups in the time of non organ failure(P>0.05), there was no significant difference in mortality rate between the two groups in 1 months(P>0.05).Conclusion It is improved that the effective respiratory support in patients with moderate to severe ARDS using APRV ventilation, it′s worthy of application and promotion.