同步间歇指令通气模式下肺内、外源性急性呼吸窘迫综合征通气治疗的效果比较

Therapeutic efficacy of synchronized intermittent mandatory ventilation in patients with pulmonary and extrapulmonary ARDS

摘要:

目的 探讨同步间歇指令通气模式下肺内、外源性急性呼吸窘迫综合征（ARDS）患者侧卧位与俯卧位治疗效果。方法 选取2020年6月—2021年12月宣城市人民医院收治的ARDS患者120例，根据病因及通气方法分为4组，其中肺内源性ARDS侧卧位治疗患者作为A组（29例）、肺外源性ARDS患者侧卧位治疗患者作为B组（30例）、肺内源性ARDS俯卧位治疗患者作为C组（31例）、肺外源性ARDS俯卧位治疗患者作为D组（30例）。对比4组患者治疗前后血气指标、呼吸力学指标、心功能指标、血流动力学指标的变化，记录患者治疗期间并发症、机械通气时间及近期预后。结果 4组患者体位变化前、体位变化1 h、体位变化3 h的PaO₂、PaO₂/FiO₂比较，结果 ①不同时间点PaO₂、PaO₂/FiO₂有差异（F =8.365和9.001，均P =0.000）；②4组患者PaO₂、PaO₂/FiO₂有差异（F =9.025和8.747，均P =0.000）；③4组患者PaO₂、PaO₂/FiO₂变化趋势有差异（F =8.779和7.988，均P =0.000）。4组患者体位变化前、体位变化1 h、体位变化3 h的气道峰压、呼吸浅快指数、HR、MAP、CVP比较，结果 ①不同时间点气道峰压、呼吸浅快指数、HR、MAP、CVP无差异（F =2.143、1.372、1.854、1.879和1.266，P =0.092、0.252、0.086、0.134和0.287）；②4组患者气道峰压、呼吸浅快指数、HR、MAP、CVP无差异（F =1.869、1.752、1.003、0.803和0.708，P =0.084、0.157、0.459、0.494和0.548）；③4组患者气道峰压、呼吸浅快指数、HR、MAP、CVP变化趋势无差异（F =2.246、1.657、1.963、2.010和2.225，P =0.079、0.177、0.080、0.114和0.086）。4组患者体位变化前、体位变化1 h、体位变化3 h的LVEF比较，结果 ①不同时间点LVEF有差异（F =6.011，P =0.000）；②4组患者LVEF无差异（F =1.957，P =0.081）；③4组患者LVEF变化趋势有差异（F =6.032，P =0.000）。4组患者治疗期间均无明显并发症发生。4组患者机械通气时间、病死率比较，差异均无统计学意义（P >0.05）。结论 同步间歇指令通气模式下肺外源性ARDS患者体位变化通气治疗血气指标改善优于肺内源性ARDS患者，俯卧位通气治疗ARDS对肺通气改善优于侧卧位。

Abstract:

Objective To investigate the therapeutic efficacy of synchronized intermittent mandatory ventilation in patients with pulmonary and extrapulmonary acute respiratory distress syndrome (ARDS) in lateral and prone positions.Methods A total of 120 ARDS patients admitted to Xuancheng People's Hospital from June 2020 to December 2021 were selected and divided into 4 groups according to the etiology and ventilation method. The patients with pulmonary ARDS treated in lateral position were recorded as group A (29 cases), patients with extrapulmonary ARDS treated in lateral position were recorded as group B (30 cases), patients with pulmonary ARDS treated in prone position were recorded as group C (31 cases), and patients with extrapulmonary ARDS treated in prone position were recorded as group D (30 cases). The changes of blood gas indicators, respiratory mechanics indexes, cardiac function indexes, and hemodynamic indexes before and after treatment were compared among the 4 groups. The incidence of complications, duration of mechanical ventilation, and short-term prognosis of the patients after treatment were recorded.Results The partial pressure of oxygen (PaO₂) and PaO₂ / fraction of inspired oxygen (FiO₂) of the 4 groups before, 1 h and 3 h after the body position change were compared via the repeated measures ANOVA, and the results demonstrated that PaO₂ and PaO₂ / FiO₂ were different among the time points (F = 8.365 and 9.001, both P = 0.000) and among the groups (F = 9.025 and 8.747, both P = 0.000). The change trends of PaO₂ and PaO₂ / FiO₂ were also different among the four groups (F = 8.779 and 7.988, both P = 0.000). The peak airway pressure, rapid shallow breathing index, heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) of the 4 groups before, 1 h and 3 h after the body position change were compared via the repeated measures ANOVA, and the results demonstrated that these indexes were not different among the time points (F = 2.143, 1.372, 1.854, 1.879 and 1.266, P = 0.092, 0.252, 0.086, 0.134 and 0.287) or among the groups (F = 1.869, 1.752, 1.003, 0.803 and 0.708, P = 0.084, 0.157, 0.459, 0.494 and 0.548). The change trends of these indexes were also not different among the groups (F = 2.246, 1.657, 1.963, 2.010 and 2.225, P = 0.079, 0.177, 0.080, 0.114 and 0.086). The left ventricular ejection fraction (LVEF) of the 4 groups before, 1 h, and 3 h after the body position change were compared via the repeated measures ANOVA, and the results demonstrated that LEVF was different among the time points (F = 6.011, P = 0.000) but not among the groups (F = 1.957, P = 0.081). There was a significant difference in the change trend of LVEF among the 4 groups (F = 6.032, P = 0.000). No severe complications occurred during the treatment period in the 4 groups. There was no significant difference in the duration of mechanical ventilation and mortality among the 4 groups (P > 0.05).Conclusions The synchronized intermittent mandatory ventilation better improves the blood gas indexes in patients with extrapulmonary ARDS than those in patients with pulmonary ARDS. In addition, mechanical ventilation in prone position outperforms that in lateral position in improving the pulmonary ventilation in patients with ARDS.