本文選題：小潮氣量通氣 + 肺復(fù)張��； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:探討小潮氣量通氣序貫肺復(fù)張(RM)治療重癥急性胰腺炎(SAP)并發(fā)ARDS患者的臨床效果。方法:選擇南昌大學(xué)第一附屬醫(yī)院重癥監(jiān)護(hù)室(ICU)收治60例SAP并發(fā)ARDS病人,按照隨機(jī)數(shù)字法進(jìn)行分組,分為小潮氣量+最佳PEEP組(對(duì)照組)和小潮氣量+最佳PEEP結(jié)合肺復(fù)張組(試驗(yàn)組),每組30例。對(duì)照組在有效治療基礎(chǔ)上均采用小潮氣量控制通氣模式(小潮氣量(6ml/Kg)+最佳PEEP的通氣策略)。當(dāng)腹腔內(nèi)壓基本正常(I級(jí)腹腔高壓)時(shí)試驗(yàn)組聯(lián)合肺復(fù)張治療,其余同對(duì)照組。通過(guò)比較兩種機(jī)械通氣策略治療下患者的臨床效果、觀察對(duì)比患者不同時(shí)間段呼吸力學(xué)參數(shù)、動(dòng)脈血?dú)饧把鲃?dòng)力學(xué)等指標(biāo)的情況。結(jié)果:(1)試驗(yàn)組(肺復(fù)張組)重癥醫(yī)學(xué)科(ICU)住院時(shí)間、機(jī)械通氣時(shí)間、VAP發(fā)生率較對(duì)照組有所降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),而試驗(yàn)組的病死率較對(duì)照組稍降低,2組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)試驗(yàn)組(肺復(fù)張組)肺靜態(tài)順應(yīng)性(Cst)升高,氣道峰壓(PIP)、平臺(tái)壓(Pplat)下降,在12、24、48、72 h同時(shí)間點(diǎn)2組Cst、PIP、Pplat比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)試驗(yàn)組(肺復(fù)張組)動(dòng)脈血Pa02、PaO2/FiO2改善,在12、24、48、72 h同時(shí)間點(diǎn)2組Pa02、PaO2/FiO2比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)肺復(fù)張即刻有一過(guò)性血流動(dòng)力學(xué)改變,同肺復(fù)張前比較有統(tǒng)計(jì)學(xué)意義(P0.05),但復(fù)張結(jié)束5min后差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:以小潮氣量+最佳PEEP為基礎(chǔ),當(dāng)腹腔壓力基本恢復(fù)正常(I級(jí)腹腔高壓)后適時(shí)應(yīng)用肺復(fù)張手法治療SAP并發(fā)ARDS,與小潮氣量機(jī)械通氣相比更利于改善順應(yīng)性和氧合,促進(jìn)塌陷的肺泡復(fù)張,縮短SAP并發(fā)ARDS病程和降低VAP發(fā)生率。
[Abstract]:Objective: to investigate the clinical effect of small tidal volume ventilation (RM) in the treatment of severe acute pancreatitis (SAP) complicated with ARDS. Methods: sixty patients with SAP complicated with ARDS in intensive care unit of the first affiliated Hospital of Nanchang University were selected and divided into groups according to random number method. They were divided into small tidal volume optimal PEEP group (control group) and small tidal volume optimal PEEP combined with lung expansion group (experimental group, 30 cases in each group). On the basis of effective treatment, the control group all adopted the best ventilation strategy of small tidal volume controlled ventilation mode (small tidal volume of 6 ml / kg). When the intraperitoneal pressure was basically normal, the experimental group combined with the treatment of pulmonary retension, and the others were the same as the control group. By comparing the clinical effects of two mechanical ventilation strategies, the parameters of respiratory mechanics, arterial blood gas and hemodynamics in different time periods were observed and compared. Results the hospitalization time and mechanical ventilation time of ICU in the experimental group (lung retension group) were lower than those in the control group. The difference was statistically significant (P 0.05), but the mortality of the trial group was slightly lower than that of the control group. There was no significant difference between the two groups.) in the experimental group (lung retensiongroup), the static compliance of the lung was increased, the peak airway pressure (PIPP) and the plateau pressure were decreased. There was a significant difference between the two groups at the same time point at 12: 24 and 48 / 72 h. There was a significant difference between the two groups. There was a significant difference between the two groups. There was a significant change in arterial blood Pa02Pao _ (2 / FiO _ 2 / FiO _ 2) in the experimental group (lung retraction group), and there was a significant change in the pulmonary hemodynamics at the same time point (P _ (0.2) Pao _ (2) / FiO _ 2) at the same time point (P _ (0.2) Pao _ (2) / FiO _ (2)) at the same time point (P _ (0.2) Pao _ (2) P _ (0.05)). There was a significant difference between the two groups before and after 5min, but there was no significant difference between the two groups after 5min. Conclusion: on the basis of optimal PEEP of small tidal volume and when the abdominal pressure basically returns to normal grade I abdominal pressure, lung reopening manipulation can be used in the treatment of SAP complicated with ARDS in good time, which is more beneficial to improve compliance and oxygenation than small tidal volume mechanical ventilation. Promote collapsed alveolar extension, shorten the course of SAP complicated with ARDS and reduce the incidence of VAP.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R563.8;R576

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 王偉;陶然;熊盟;詹亞琨;程斌;;生大黃聯(lián)合微生態(tài)制劑對(duì)重癥急性胰腺炎急性肺損傷患者的治療作用[J];中國(guó)中西醫(yī)結(jié)合急救雜志;2015年01期

2 肖貞良;周菁;陳章;吳奎;李曉華;;糖皮質(zhì)激素治療對(duì)急性呼吸窘迫綜合征患者預(yù)后的影響[J];中國(guó)中西醫(yī)結(jié)合急救雜志;2015年01期

3 袁亮;朱曦;;中性粒細(xì)胞彈性蛋白酶及其抑制劑在急性呼吸窘迫綜合征中作用的研究進(jìn)展[J];中華危重病急救醫(yī)學(xué);2014年05期

4 楊舟;沈鋒;;戊乙奎醚聯(lián)合機(jī)械通氣對(duì)鹽酸吸入性急性呼吸窘迫綜合征大鼠炎癥反應(yīng)的影響[J];中國(guó)中西醫(yī)結(jié)合急救雜志;2014年01期

5 許才明;陳海龍;;CD147與急性肺損傷的研究進(jìn)展[J];中華危重病急救醫(yī)學(xué);2013年12期

6 王興鵬;李兆申;袁耀宗;杜奕奇;曾悅;;中國(guó)急性胰腺炎診治指南(2013年,上海)[J];臨床肝膽病雜志;2013年09期

7 董亮;邱海波;;急性呼吸窘迫綜合征肺容積減少的機(jī)制與肺開(kāi)放策略的選擇[J];實(shí)用醫(yī)院臨床雜志;2010年03期

，

本文編號(hào)：1796266