适应性支持通气加肺复张在颅脑损伤合并急性呼吸窘迫综合征患者中的应用价值

目的探讨适应性支持通气加肺复张在颅脑损伤合并急性呼吸窘迫综合征患者中的应用价值。方法选择我院2011年4月-2015年6月重症监护室收治的70例颅脑损伤合并急性呼吸窘迫综合征患者为研究对象。随机分为对照组和观察组,对照组行同步间隙性指令通气(SIMV),观察组行适应性支持通气(ASV)和肺复张治疗,记录两组患者的呼吸力学、血气、氧代谢指标和颅内压。结果治疗后观察组患者的气道峰值压、平台压、平均气道压均低于对照组,肺动态顺应性高于对照组,差异均有统计学意义(P0.05)。治疗后两组患者的p H值、Pa O2和Pa CO2比较,差异无统计学意义(P0.05),但对照组和观察组在治疗前后组内比较,差异有统计学意义(P0.05)。治疗后两组患者的颅内压降低,动脉血氧分压、机体氧供、氧耗增加,且观察组优于对照组,差异有统计学意义(P0.05)。结论适应性支持通气加肺复张可有效降低呼吸力学参数和颅内压,增加氧代谢指标,有利于在颅脑损伤合并急性呼吸窘迫综合征的治疗。

Application value of adaptive support ventilation combined with pulmonary rehabilitation in patients with craniocerebral injury complicated with acute respiratory distress syndrome

Objective To investigate the application value of adaptive support ventilation combined with pul-monary rehabilitation in patients with craniocerebral injury complicated with acute respiratory distress syndrome. Methods 70 cases of craniocerebral injury complicated with acute respiratory distress syndrome in our hospital from June 2015 to April 2011 were selected as the research object, and they were randomly divided into the control group and the observation group. The control group was treated with SIMV, and the observation group was treated with a-daptive support ventilation ( ASV) and pulmonary rehabilitation. Their respiratory mechanics, blood gas, oxygen me-tabolism index and intracranial pressure were recorded. Results Airway peak pressure, platform and mean airway pressure in the observation group after treatment were significantly lower than those in the control group (P<0. 05). After treatment, the differences in PH value, PaO2 value and PaCO2 value in the two groups were not statistically sig-nificant (P>0. 05), which was statistically significant in the two groups before and after treatment (P<0. 05). Af-ter treatment, intracranial pressure decreased in the two groups, and arterial oxygen partial pressure, oxygen supply and oxygen consumption increased. The difference was more pronounced in the observation group than in the control group (P<0. 05). Conclusion Adaptive support ventilation combined with pulmonary rehabilitation can effectively reduce the respiratory mechanics parameters and intracranial pressure, increase oxygen metabolism index, which is conducive to the treatment of brain injury with acute respiratory distress syndrome.