氮氧通气与氦氧通气在中重度急性呼吸窘迫综合征患者中应用效果的对比研究

Effects of nitrogen-oxygen ventilation versus heliox ventilation in patients with moderate-to-severe acute respiratory distress syndrome

摘要:

目的 比较氮氧通气与氦氧通气在中重度急性呼吸窘迫综合征（ARDS）患者中的应用效果。方法 选取2023年6月—2025年1月福建医科大学附属龙岩第一医院收治的112例中重度ARDS患者，通过随机数字表法分为对照组和观察组，各56例。对照组接受氮氧通气，观察组接受氦氧通气。比较两组机械通气时间、总住院时间、住院费用、炎症因子水平［C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）］、血气指标［动脉血二氧化碳分压（PaCO₂）、动脉血氧分压（PaO₂）］、短期预后（并发症及28 d病死率）。结果 观察组机械通气时间、总住院时间均短于对照组，住院费用低于对照组（P <0.05）。观察组与对照组通气前、通气后第1和3天BALF中CRP、IL-6、TNF-α水平比较，结果 ①不同时间点CRP、IL-6、TNF-α水平比较，差异均有统计学意义（P <0.05）。②观察组与对照组BALF中CRP、IL-6、TNF-α水平比较，差异均有统计学意义（P <0.05）；观察组BALF中CRP、IL-6、TNF-α水平均低于对照组。③观察组与对照组BALF中CRP、IL-6、TNF-α水平变化趋势比较，差异均有统计学意义（P <0.05）。观察组通气后第3天PaCO₂水平低于对照组，PaO₂水平高于对照组（P <0.05）。两组通气后第3天PaCO₂水平均低于通气前，PaO₂水平均高于通气前（P <0.05）。观察组与对照组低血压、低血氧发生率比较，差异均无统计学意义（P >0.05）。观察组28 d病死率低于对照组（P <0.05）。结论 相较于氮氧通气，氦氧通气可有效降低中重度ARDS患者气道压力、减轻肺部炎症反应，改善血气指标，降低28 d病死率，整体治疗效果更佳。

Abstract:

Objective To compare the effects of nitrogen-oxygen ventilation versus heliox ventilation in patients with moderate-to-severe acute respiratory distress syndrome (ARDS).Methods A total of 112 patients with moderate-to-severe ARDS admitted to the Longyan First Hospital Affiliated to Fujian Medical University between June 2023 and January 2025 were selected. Using a random number table, they were divided into a control group and an observation group, each comprising 56 patients. The control group received nitrogen-oxygen ventilation, whilst the observation group received heliox ventilation. The two groups were compared in terms of the duration of mechanical ventilation, total length of hospital stay, hospital costs, levels of inflammatory markers [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) ], blood gas parameters [partial pressure of carbon dioxide in arterial blood (PaCO₂), partial pressure of oxygen in arterial blood (PaO₂) ], short-term prognosis (complications and the 28-day mortality rate).Results The duration of mechanical ventilation and the total length of hospital stay were shorter, and the hospital costs were lower in the observation group than in the control group (P < 0.05). Comparison of CRP, IL-6 and TNF-α levels in bronchoalveolar lavage fluid (BALF) between the observation group and the control group before mechanical ventilation and on days 1 and 3 of ventilation showed that there were statistically significant differences in CRP, IL-6 and TNF-α levels across the time points (P < 0.05) and between the groups (P < 0.05), with their levels in the observation group being lower than those in the control group. A comparison of the change trends of CRP, IL-6 and TNF-α levels in BALF between the observation group and the control group revealed statistically significant differences (P < 0.05). On day 3 of mechanical ventilation, PaCO₂ in the observation group was lower than that in the control group, whilst PaO₂ was higher in the observation group (P < 0.05). On day 3 of mechanical ventilation, PaCO₂ was lower and PaO₂ was higher in both groups compared with pre-ventilation values (P < 0.05). There was no statistically significant difference in the incidence of hypotension or hypoxemia between the observation group and the control group (P > 0.05). The 28-day mortality rate in the observation group was lower than that in the control group (P < 0.05).Conclusion Compared with nitrogen-oxygen ventilation, heliox ventilation effectively reduces airway pressure, alleviates pulmonary inflammatory responses, improves blood gas parameters, and lowers the 28-day mortality rate in patients with moderate-to-severe ARDS, resulting in better overall therapeutic outcomes.