压力释放通气模式与肺保护性通气治疗急性呼吸窘迫综合征对比研究.docVIP

压力释放通气模式与肺保护性通气治疗急性呼吸窘迫综合征对比研究 　　[摘要]目的 探?压力释放通气模式（APRV）与肺保护性通气（SIMV）治疗急性呼吸窘迫综合征的效果。方法 选取2016年11月～2017年11月我院收治的94例急性呼吸窘迫综合征患者作为研究对象，按照随机数字表法分为两组，每组各47例。SIMV组实施SIMV，APRV组采取APRV。比较两组通气前及通气2 d后动脉血气指标、气道力学、血流动力学及肺损伤程度。结果 通气前两组患者氧合指数（PaO2/FiO2）、外肺水指数（ELWI）、气道峰压（Ppeak）、气道平均压（Pmean）比较，差异无统计学意义（P0.05）；通气后SIMV组PaO2/FiO2比APRV组低，ELWI、Ppeak、Pmean比APRV组高，差异均有统计学意义（P0.05）；通气2 d后SIMV组HR、CVP、Murray评分比APRV组高，MAP比APRV组低，差异均有统计学意义（P0.05）。结论 与SIMV比较，APRV用于急性呼吸窘迫综合患者通气治疗中效果更加显著，利于患者的呼吸功能及肺复张，且能够促进机体血流动力学的改善，更加利于患者康复治疗。 　　[关键词]急性呼吸窘迫综合征；压力释放通气模式；肺保护性通气；肺损伤；血流动力学 　　[中图分类号] R563.8 [文献标识码] A [文章编号] 1674-4721（2018）3（c）-0043-03 　　[Abstract]Objective To explore the effects of airway pressure release ventilation （APRV） and lung protective ventilation （SIMV） on acute respiratory distress syndrome.Methods 94 patients with acute respiratory distress syndrome admitted to our hospital from November 2016 to November 2017 were selected as the research subject，and were divided into two groups （n=47） according to the random number table method.Pulmonary protective ventilation was performed in the SIMV group and airway pressure release ventilation was applied in the APRV group.The arterial blood gas index，airway mechanics，hemodynamics and lung injury were compared between the two groups before ventilation and 2 days after ventilation.Results There was no significant difference in PaO2/FiO2，ELWI，Ppeak and Pmean between the two groups before ventilation （P0.05）.After ventilation，however，the PaO2/FiO2 in the SIMV group was shown to be lower than that in the APRV group，while the ELWI，Ppeak and Pmean were higher than that in the APRV group，the differences were statistically significant（P0.05）.After 2 days of ventilation，the HRV，CVP and Murray scores in the SIMV group were shown to be higher than those in the APRV group，and the MAP was lower than that in the APRV group，the differences were statistically significant（P0.05）.Conclusion Compared with SIMV，APRV is more effective in the treatment of patients wi