本文選題：急性呼吸窘迫綜合征 + 肺復(fù)張��； 參考：《武漢大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2014年06期

【摘要】：目的:研究?jī)煞N不同肺復(fù)張策略在急性呼吸窘迫綜合征治療中的應(yīng)用效果。方法:選擇我院接診的60例急性呼吸窘迫綜合征的患者設(shè)計(jì)試驗(yàn)進(jìn)行研究。按照隨機(jī)數(shù)表法,將患者分為A、B兩組。A組采用雙水平正壓通氣+壓力支持通氣模式改良嘆氣法的肺復(fù)張策略對(duì)患者實(shí)施肺復(fù)張,B組采用壓力控制法的肺復(fù)張策略對(duì)患者實(shí)施肺復(fù)張。分別檢測(cè)記錄兩組患者肺復(fù)張(RM)前后的各項(xiàng)呼吸指標(biāo)和血流動(dòng)力學(xué)的變化情況,并記錄患者的機(jī)械通氣時(shí)間、ICU住院時(shí)間及術(shù)后并發(fā)癥的發(fā)生情況。結(jié)果:RM前,兩組患者的PaO2/FiO2及Cstat無(wú)顯著性差異(P0.05);RM 30,60min后,患者的PaO2/FiO2及Cstat均較RM前明顯升高(P0.05),但兩組比較無(wú)顯著性差異(P0.05);RM 2h后,A組患者的PaO2/FiO2及Cstat的水平明顯高于B組,兩組比較有顯著性差異(P0.05)。RM前,兩組患者的HR、MAP、CVP水平均無(wú)顯著性差異(P0.05);RM 5min后,兩組患者的HR、MAP、CVP水平與RM前有顯著性差異(P0.05);RM 10min后,A組患者的HR、MAP、CVP水平均得到明顯改善,與RM前無(wú)顯著性差異,B組患者的HR、MAP、CVP水平仍與RM前有顯著性差異;RM 20min后,兩組患者的HR、MAP、CVP水平與RM前無(wú)顯著性差異(P0.05)。A組的機(jī)械通氣時(shí)間和ICU住院時(shí)間均明顯短于B組,兩組比較有統(tǒng)計(jì)學(xué)意義(P0.01)。所有患者在肺復(fù)張后,床邊正位胸片顯示均未發(fā)生氣胸、縱隔氣腫,但A組中合并多器官功能衰竭的患者有2例,B組中合并多器官功能衰竭的患者有3例,兩組比較無(wú)顯著性差異(P0.05)。結(jié)論:雙水平正壓通氣+壓力支持通氣模式改良嘆氣法對(duì)急性呼吸窘迫綜合征患者實(shí)施肺復(fù)張,效果良好,安全性高,值得臨床推廣應(yīng)用。
[Abstract]:Objective: to study the effect of two different strategies of pulmonary retension in the treatment of acute respiratory distress syndrome (ARDS). Methods: 60 patients with acute respiratory distress syndrome (ARDS) received in our hospital were studied. According to the random number table method, The patients were divided into two groups: group A and group A. The patients were treated with the strategy of lung reopening with double level positive pressure ventilation and modified sigh method. Group B was treated with the strategy of pulmonary reopening with the method of pressure control. The changes of respiratory index and hemodynamics before and after pulmonary retraction were recorded, and the time of mechanical ventilation, the time of ICU hospitalization and the occurrence of postoperative complications were recorded. Results there was no significant difference in PaO2/FiO2 and Cstat between the two groups before and after 30 minutes. The levels of PaO2/FiO2 and Cstat in group A were significantly higher than those in group B after 30 minutes, but there was no significant difference between the two groups in the levels of PaO2/FiO2 and Cstat in group A. There was no significant difference in the levels of HRP MAPCVP between the two groups before and after P0.05 5min. There was a significant difference between the two groups in the level of HRP MAPP CVP and that in group A (P 0.05) after RM 10min. There was a significant improvement in the level of HRP MAPP CVP in group A after P0.05 10min, and there was no significant difference between the two groups in the level of HRP MAPP CVP in group A after P0.05 5min, and there was a significant difference between the two groups in the level of HRP MAPCVP before and after RM 10min. There was no significant difference in the level of HRP MAPCVP between group B and group B after RM 20min. There was no significant difference between group B and group B before RM. The duration of mechanical ventilation and the hospitalization time of ICU in group A were significantly shorter than those in group B. There was significant difference between the two groups (P 0.01). All the patients had no pneumothorax and mediastinal emphysema on chest radiographs by the bedside after reopening of the lung, but there were 2 patients with multiple organ failure in group A and 3 patients with multiple organ failure in group B. There was no significant difference between the two groups (P 0.05). Conclusion: the modified exclamatory method for patients with acute respiratory distress syndrome by double level positive pressure pressure support ventilation has good effect and high safety. It is worth popularizing in clinic.
【作者單位】： 華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬梨園醫(yī)院急診科;華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬梨園醫(yī)院兒科;
【分類號(hào)】：R563.8

【參考文獻(xiàn)】

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