俯卧位通气治疗重度急性呼吸窘迫综合征的临床效果(1)
[摘要]目的 探討重度急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)应用俯卧位通气治疗的效果。方法 选取2015年6月～2017年8月我院重症加强护理病房(ICU)收治的48例重度ARDS患者作为研究对象，采用随机数字表法将其分为A和B组，每组各24例，另选择24例轻中度ARDS患者作为C组。A、C组实施俯卧位通气治疗，B组采取仰卧位通气治疗。比较A、B两组的血流动力学指标[心率(HR)、心脏指数(CI)、中心静脉压(CVP)以及平均动脉压(MAP)]；比较三组治疗前后的氧合指数水平；比较A、B两组的不良事件发生率及预后指标(入住ICU时间、28 d内机械通气时间)。结果 治疗后，A、B组两组的HR、CI、CVP、MAP指标比较，差异无统计学意义(P>0.05)。治疗后，A组的氧合指数低于C组，高于B组，差异有统计学意义(P<0.05)；B组的氧合指数低于C组，差异有统计学意义(P<0.05)。A组的不良事件总发生率低于B组，差异有统计学意义(P<0.05)。A组的入住ICU时间与28 d内机械通气时间短于B组，差异有统计学意义(P<0.05)。结论 对重度ARDS患者，俯卧位通气治疗可改善氧合，减少不良事件，缩短机械通气时间，加快症状缓解，增强治疗效果。
[关键词]重度ARDS；俯卧位通气治疗；血流动力学；氧合；预后
[中图分类号] R563.8 [文献标识码] A [文章编号] 1674-4721(2018)8(a)-0051-03
Clinical effect of prone position ventilation for severe acute respiratory distress syndrome
XIAN Ling-jun TANG Shao-xuan TAN Qi-jia YE Guo-hua
Intensive Care Unit， Yunfu Traditional Chinese Medicine Hospital， Guangdong Province， Yunfu 527300， China
[Abstract] Objective To investigate the effect of prone position ventilation for severe acute respiratory distress syndrome (ARDS). Methods A total of 48 patients with severe ARDS who were admitted to our Intensive Care Unit from June 2015 to August 2017 were selected. By a random number table method， they were equally divided into groups A and groups B. Another batch of 24 mild to moderate ARDS was selected as group C. Patients in group A and C were treated with prone position ventilation， while in group B， patients were treated with supine position ventilation. Hemodynamic parameters including heart rate (HR)， cardiac index (CI)， central venous pressure (CVP) and mean arterial pressure (MAP) between the groups A and B were compared. The levels of oxygenation index before and after treatment among the three groups were compared. The incidence of adverse events and prognostic indicators such as time of ICU stay and mechanical ventilation time within 28 days between the groups A and B were compared. Results After treatment， there was no significant difference in HR， CI， CVP or MAP between the groups A and B (P>0.05). After treatment， the oxygenation index of group A was lower than that of group C， but higher than that of group B (P<0.05). The oxygenation index of group B was lower than that of group C with a significant difference (P<0.05). The total incidence of adverse events in group A was lower than that in group B with a significant difference (P<0.05). The ICU stay in group A and mechanical ventilation time within 28 days were both shorter compared with those in group B with statistical significance (P<0.05). Conclusion For patients with severe ARDS， prone position ventilation can improve the oxygenation， reduce adverse events， shorten mechanical ventilation time， speed up symptom relief， and enhance therapeutic efficacy., http://www.100md.com(冼凌军 汤少铉 谭其佳)
[关键词]重度ARDS；俯卧位通气治疗；血流动力学；氧合；预后
[中图分类号] R563.8 [文献标识码] A [文章编号] 1674-4721(2018)8(a)-0051-03
Clinical effect of prone position ventilation for severe acute respiratory distress syndrome
XIAN Ling-jun TANG Shao-xuan TAN Qi-jia YE Guo-hua
Intensive Care Unit， Yunfu Traditional Chinese Medicine Hospital， Guangdong Province， Yunfu 527300， China
[Abstract] Objective To investigate the effect of prone position ventilation for severe acute respiratory distress syndrome (ARDS). Methods A total of 48 patients with severe ARDS who were admitted to our Intensive Care Unit from June 2015 to August 2017 were selected. By a random number table method， they were equally divided into groups A and groups B. Another batch of 24 mild to moderate ARDS was selected as group C. Patients in group A and C were treated with prone position ventilation， while in group B， patients were treated with supine position ventilation. Hemodynamic parameters including heart rate (HR)， cardiac index (CI)， central venous pressure (CVP) and mean arterial pressure (MAP) between the groups A and B were compared. The levels of oxygenation index before and after treatment among the three groups were compared. The incidence of adverse events and prognostic indicators such as time of ICU stay and mechanical ventilation time within 28 days between the groups A and B were compared. Results After treatment， there was no significant difference in HR， CI， CVP or MAP between the groups A and B (P>0.05). After treatment， the oxygenation index of group A was lower than that of group C， but higher than that of group B (P<0.05). The oxygenation index of group B was lower than that of group C with a significant difference (P<0.05). The total incidence of adverse events in group A was lower than that in group B with a significant difference (P<0.05). The ICU stay in group A and mechanical ventilation time within 28 days were both shorter compared with those in group B with statistical significance (P<0.05). Conclusion For patients with severe ARDS， prone position ventilation can improve the oxygenation， reduce adverse events， shorten mechanical ventilation time， speed up symptom relief， and enhance therapeutic efficacy., http://www.100md.com(冼凌军 汤少铉 谭其佳)