本文選題：急性呼吸窘迫征 + 肺復(fù)張��； 參考：《石河子大學(xué)》2016年碩士論文

【摘要】：目的:在對ARDS機(jī)械通氣患者行肺復(fù)張時,觀察在4種不同氧濃度條件下ARDS患者肺復(fù)張過程中呼吸力學(xué)、血?dú)夥治觥⒀鲃恿W(xué)指標(biāo)的變化,探討不同氧濃度在ARDS患者肺復(fù)張時的臨床意義,為提出改善并穩(wěn)定ARDS患者呼吸力學(xué)、氧和、血流動力學(xué)的最佳肺復(fù)張氧濃度提供依據(jù)。方法:80例ARDS機(jī)械通氣患者納入本試驗(yàn)。將4種不同氧濃度肺復(fù)張方法隨機(jī)實(shí)施于每位患者,依次為:A組,給氧濃度(Fi O2)為30%,B組,Fi O2為40%,C組,Fi O2為50%,D組,Fi O2為60%。比較4組ARDS患者肺復(fù)張前后不同時間點(diǎn)平臺壓(Pplat)、氣道峰壓(Ppeak)、肺復(fù)張容積(RV)、肺靜態(tài)順應(yīng)性(Cst)、動脈血氧分壓(Pa O2)、動脈血氧飽和度(Sa O2)、動脈血二氧化碳分壓(Pa CO2)、酸堿度(PH)、平均動脈壓(MAP)、中心靜脈壓(CVP)和心率(HR)的變化。采用SPSS17.0建立數(shù)據(jù)庫,計量資料以均數(shù)±標(biāo)準(zhǔn)差(x±S)表示,不同氧濃度RM的重復(fù)測量資料比較采用重復(fù)測量資料的方差分析。,以P0.05表明差異有統(tǒng)計學(xué)意義。結(jié)果:1.對ARDS患者呼吸力學(xué)指標(biāo)的影響:在對4組患者行肺復(fù)張前,4組患者呼吸力學(xué)指標(biāo)比較差異無統(tǒng)計學(xué)意義(P0.05);肺復(fù)張后4組患者肺復(fù)張容積(RV)較前明顯增加,B組RV增幅大于其他三組,差異均有統(tǒng)計學(xué)意義(P0.05);復(fù)張后1h,B、C、D三組平臺壓(Pplat)、氣道峰壓(Ppeak)較前降低,復(fù)張后30min,,B組Pplat、Ppeak和肺靜態(tài)順應(yīng)性(Cst)較前改善,差異均有統(tǒng)計學(xué)意義(P0.05),A、C、D組無明顯改變,差異無統(tǒng)計學(xué)意義(P0.05)。2.對ARDS患者血?dú)夥治龅挠绊?在對4組ARDS患者行肺復(fù)張前,4組患者Pa O2、Sa O2、Pa O2/Fi O2指標(biāo)比較,差異無統(tǒng)計學(xué)意義(P0.05),肺復(fù)張后,4組患者Pa O2、Sa O2、Pa O2/Fi O2指標(biāo)高于復(fù)張前水平,差異有統(tǒng)計學(xué)意義(P0.05),在肺復(fù)張后各監(jiān)測時點(diǎn)4組患者Pa O2、Pa O2/Fi O2比較,差異均有統(tǒng)計學(xué)意義(P0.05);肺復(fù)張前后,4組患者Pa CO2和PH無明顯改變(P0.05)。3.對ARDS患者血流動力學(xué)的影響:在對4組ARDS患者行肺復(fù)張前,4組患者M(jìn)AP、CVP和HR指標(biāo)比較,差異無統(tǒng)計學(xué)意義(P0.05),在對4組患者行肺復(fù)張時,患者M(jìn)AP指標(biāo)低于復(fù)張前,CVP和HR指標(biāo)高于復(fù)張前,差異均有統(tǒng)計學(xué)意義(P0.05),復(fù)張后5min,4組患者M(jìn)AP、CVP和HR指標(biāo)恢復(fù)至原水平。結(jié)論:1.不同氧濃度肺復(fù)張均可改善ARDS患者呼吸力學(xué)指標(biāo),提高氧和水平,對血流動力學(xué)影響較小。2.采用40%氧濃度肺復(fù)張可更快改善ARDS患者Pplat、Ppeak和Cst,更大程度增加RV,在滿足氧供的情況下避免了高濃度氧氣吸入,達(dá)到并維持更好的復(fù)張效果。3.在本試驗(yàn)對ARDS患者肺復(fù)張的過程中,未出現(xiàn)氣壓傷、低氧血癥等嚴(yán)重并發(fā)癥,是一種安全有效的治療措施,且采用40%氧濃度肺復(fù)張效果更好,值得臨床推廣。
[Abstract]:Objective: to observe the changes of respiratory mechanics, blood gas analysis and hemodynamics in patients with ARDS during pulmonary reopening under four different oxygen concentrations. To explore the clinical significance of different oxygen concentrations in the patients with ARDS during pulmonary reopening, and to provide a basis for improving and stabilizing the respiratory mechanics, oxygen and hemodynamics of patients with ARDS. Methods 80 patients with ARDS mechanical ventilation were included in this study. Four different oxygen concentration lung reopening methods were randomly performed in each patient, followed by group A (n = 30), group B (n = 30), group B (n = 30), group C (n = 40), group C (n = 50), group D (n = 50), group D (n = 60). A comparison was made between the four groups of ARDS patients at different time points before and after pulmonary resuscitation, such as plateau pressure, peak airway pressure, pulmonary volume volume, pulmonary static compliance, arterial partial pressure of oxygen (Pao _ 2), arterial oxygen saturation (SAO _ 2), arterial carbon dioxide partial pressure (Paco _ 2), acidity and alkalinity. The changes of mean arterial pressure (MAPP), central venous pressure (CVP) and heart rate (HRV). SPSS17.0 was used to establish the database, and the measurement data were expressed as mean 鹵standard deviation (x 鹵S). The repeated measurement data of different oxygen concentration RM were compared by the analysis of variance of repeated measurement data. The result is 1: 1. The effect of ARDS on respiratory mechanical indexes: there was no significant difference in respiratory mechanical indexes between the 4 groups before and after pulmonary resuscitation (P 0.05), and the volume of pulmonary retension was significantly increased in the 4 groups after pulmonary reopening compared with the previous group (P < 0.05). Larger than the other three groups, The differences were statistically significant (P 0.05), and the peak airway pressure (Ppeak) and peak airway pressure (Ppeak) were lower in group B than those in group C at 1 h after resuscitation, but there was no significant difference between group B and group C (P 0.05%), but there was no significant difference between group C (P 0.05) and group C (P 0.05 路2) at 30 min after resuscitation, and there was no significant difference between group C (P 0.05) and group C (P 0.05 路2) at 30 min after resuscitation (P > 0.05), but there was no significant difference between group B and group B (P < 0.05). The effect of blood gas analysis on ARDS patients: there was no significant difference in the indexes of PaO2-Sa-O2-O2Pa O2/Fi O _ 2 between four groups of ARDS patients before and after pulmonary reopening, but the level of O2/Fi O _ 2 in four groups of patients after pulmonary reopening was higher than that before re-tensioning. The difference was statistically significant (P 0.05), and there was no significant difference in Pa CO2 and PH between the 4 groups before and after pulmonary resuscitation, and there was no significant difference between the four groups (P 0.05) and PH (P 0.05 路3) before and after the pulmonary resuscitation (P < 0.05), and there was no significant difference between the four groups (P 0.05) before and after the pulmonary resuscitation (P < 0.05). Hemodynamic changes in ARDS patients: there was no significant difference in ARDS and HR between four groups of ARDS patients before and after pulmonary retension.There was no significant difference between the four groups (P 0.05), but there was no significant difference between the four groups when the patients were treated with pulmonary retension.There was no significant difference between the two groups. The MAP and HR of the patients were lower than those of the patients before and after the resuscitation, and the differences were statistically significant (P 0.05). The levels of MAP and HR in the 4 groups recovered to the original level 5 minutes after the reloading. Conclusion 1. Different oxygen concentration can improve respiratory mechanics index, increase oxygen and level, and have little effect on hemodynamics in patients with ARDS. The 40% oxygen concentration of Fu Fu Zhang Ke was used to improve Pplaton Ppeak and CST of ARDS patients more quickly, to a greater extent, to avoid high concentration oxygen inhalation under the condition of oxygen supply, and to achieve and maintain a better effect of retension.3. There were no severe complications such as air pressure injury, hypoxemia and so on in the course of pulmonary retension in patients with ARDS. It is a safe and effective treatment measure, and the effect of 40% oxygen concentration is better, which is worth popularizing in clinic.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R563.8

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