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目的:研究两种不同肺复张策略在急性呼吸窘迫综合征治疗中的应用效果。方法:选择我院接诊的60例急性呼吸窘迫综合征的患者设计试验进行研究。按照随机数表法,将患者分为A、B两组。A组采用双水平正压通气+压力支持通气模式改良叹气法的肺复张策略对患者实施肺复张,B组采用压力控制法的肺复张策略对患者实施肺复张。分别检测记录两组患者肺复张(RM)前后的各项呼吸指标和血流动力学的变化情况,并记录患者的机械通气时间、ICU住院时间及术后并发症的发生情况。结果:RM前,两组患者的PaO2/FiO2及Cstat无显著性差异(P>0.05);RM 30,60min后,患者的PaO2/FiO2及Cstat均较RM前明显升高(P<0.05),但两组比较无显著性差异(P>0.05);RM 2h后,A组患者的PaO2/FiO2及Cstat的水平明显高于B组,两组比较有显著性差异(P<0.05)。RM前,两组患者的HR、MAP、CVP水平均无显著性差异(P>0.05);RM 5min后,两组患者的HR、MAP、CVP水平与RM前有显著性差异(P<0.05);RM 10min后,A组患者的HR、MAP、CVP水平均得到明显改善,与RM前无显著性差异,B组患者的HR、MAP、CVP水平仍与RM前有显著性差异;RM 20min后,两组患者的HR、MAP、CVP水平与RM前无显著性差异(P>0.05)。A组的机械通气时间和ICU住院时间均明显短于B组,两组比较有统计学意义(P<0.01)。所有患者在肺复张后,床边正位胸片显示均未发生气胸、纵隔气肿,但A组中合并多器官功能衰竭的患者有2例,B组中合并多器官功能衰竭的患者有3例,两组比较无显著性差异(P>0.05)。结论:双水平正压通气+压力支持通气模式改良叹气法对急性呼吸窘迫综合征患者实施肺复张,效果良好,安全性高,值得临床推广应用。
Objective: To study the effect of two different pulmonary recurrent strategies in the treatment of acute respiratory distress syndrome. Methods: A total of 60 patients with acute respiratory distress syndrome admitted to our hospital were selected to study the design test. According to random number table method, the patients were divided into A and B groups. In group A, pulmonary reexpansion was performed by double-level positive-pressure ventilation and pressure-assisted ventilation with modified sigh method. Patients in group A underwent pulmonary reexpansion using pressure-control strategy. The changes of respiratory index and hemodynamics before and after pulmonary re-scription (RM) were recorded and recorded. The mechanical ventilation time, ICU length of hospital stay and postoperative complications were recorded. Results: There was no significant difference in PaO2 / FiO2 and Cstat between the two groups before RM (P> 0.05). PaO2 / FiO2 and Cstat in patients after RM 30 and 60min were significantly higher than those before RM (P <0.05) However, there was no significant difference between the two groups (P> 0.05). After 2 hours of RM, the PaO2 / FiO2 and Cstat levels in group A were significantly higher than those in group B, with significant difference between the two groups (P <0.05). There were no significant differences in HR, MAP and CVP levels between the two groups before RM (P> 0.05). After 5 minutes of RM, HR, MAP and CVP levels in both groups were significantly different from those before RM (P <0.05) ; After 10 minutes of RM, the HR, MAP and CVP levels of patients in group A were significantly improved, with no significant difference compared with those before RM, the HR, MAP and CVP levels in group B were still significantly different from those before RM; after RM 20 minutes There were no significant differences in HR, MAP and CVP levels between the two groups before and after RM (P> 0.05). The duration of mechanical ventilation and ICU stay in group A were significantly shorter than those in group B, with statistical significance (P <0.01). All patients in the lung after recanalization, bedside chest radiograph showed no pneumothorax, mediastinal emphysema, but in group A, patients with multiple organ failure in 2 cases, B group with multiple organ failure patients 3 cases, no significant difference between the two groups (P> 0.05). Conclusions: The double-level positive pressure ventilation and pressure support ventilation mode improved sigh method in patients with acute respiratory distress syndrome pulmonary reexpansion, the effect is good, safe, it is worthy of clinical application.