發(fā)布時間：2018-04-24 10:29

  本文選題：小潮氣量通氣 + 肺復張��； 參考：《南昌大學》2017年碩士論文

【摘要】：目的:探討小潮氣量通氣序貫肺復張(RM)治療重癥急性胰腺炎(SAP)并發(fā)ARDS患者的臨床效果。方法:選擇南昌大學第一附屬醫(yī)院重癥監(jiān)護室(ICU)收治60例SAP并發(fā)ARDS病人,按照隨機數(shù)字法進行分組,分為小潮氣量+最佳PEEP組(對照組)和小潮氣量+最佳PEEP結(jié)合肺復張組(試驗組),每組30例。對照組在有效治療基礎(chǔ)上均采用小潮氣量控制通氣模式(小潮氣量(6ml/Kg)+最佳PEEP的通氣策略)。當腹腔內(nèi)壓基本正常(I級腹腔高壓)時試驗組聯(lián)合肺復張治療,其余同對照組。通過比較兩種機械通氣策略治療下患者的臨床效果、觀察對比患者不同時間段呼吸力學參數(shù)、動脈血氣及血流動力學等指標的情況。結(jié)果:(1)試驗組(肺復張組)重癥醫(yī)學科(ICU)住院時間、機械通氣時間、VAP發(fā)生率較對照組有所降低,差異有統(tǒng)計學意義(P0.05),而試驗組的病死率較對照組稍降低,2組比較差異無統(tǒng)計學意義(P0.05)。(2)試驗組(肺復張組)肺靜態(tài)順應(yīng)性(Cst)升高,氣道峰壓(PIP)、平臺壓(Pplat)下降,在12、24、48、72 h同時間點2組Cst、PIP、Pplat比較差異有統(tǒng)計學意義(P0.05)。(3)試驗組(肺復張組)動脈血Pa02、PaO2/FiO2改善,在12、24、48、72 h同時間點2組Pa02、PaO2/FiO2比較差異有統(tǒng)計學意義(P0.05)。(4)肺復張即刻有一過性血流動力學改變,同肺復張前比較有統(tǒng)計學意義(P0.05),但復張結(jié)束5min后差異無統(tǒng)計學意義(P0.05)。結(jié)論:以小潮氣量+最佳PEEP為基礎(chǔ),當腹腔壓力基本恢復正常(I級腹腔高壓)后適時應(yīng)用肺復張手法治療SAP并發(fā)ARDS,與小潮氣量機械通氣相比更利于改善順應(yīng)性和氧合,促進塌陷的肺泡復張,縮短SAP并發(fā)ARDS病程和降低VAP發(fā)生率。
[Abstract]:Objective: to investigate the clinical effect of small tidal volume ventilation (RM) in the treatment of severe acute pancreatitis (SAP) complicated with ARDS. Methods: sixty patients with SAP complicated with ARDS in intensive care unit of the first affiliated Hospital of Nanchang University were selected and divided into groups according to random number method. They were divided into small tidal volume optimal PEEP group (control group) and small tidal volume optimal PEEP combined with lung expansion group (experimental group, 30 cases in each group). On the basis of effective treatment, the control group all adopted the best ventilation strategy of small tidal volume controlled ventilation mode (small tidal volume of 6 ml / kg). When the intraperitoneal pressure was basically normal, the experimental group combined with the treatment of pulmonary retension, and the others were the same as the control group. By comparing the clinical effects of two mechanical ventilation strategies, the parameters of respiratory mechanics, arterial blood gas and hemodynamics in different time periods were observed and compared. Results the hospitalization time and mechanical ventilation time of ICU in the experimental group (lung retension group) were lower than those in the control group. The difference was statistically significant (P 0.05), but the mortality of the trial group was slightly lower than that of the control group. There was no significant difference between the two groups.) in the experimental group (lung retensiongroup), the static compliance of the lung was increased, the peak airway pressure (PIPP) and the plateau pressure were decreased. There was a significant difference between the two groups at the same time point at 12: 24 and 48 / 72 h. There was a significant difference between the two groups. There was a significant difference between the two groups. There was a significant change in arterial blood Pa02Pao _ (2 / FiO _ 2 / FiO _ 2) in the experimental group (lung retraction group), and there was a significant change in the pulmonary hemodynamics at the same time point (P _ (0.2) Pao _ (2) / FiO _ 2) at the same time point (P _ (0.2) Pao _ (2) / FiO _ (2)) at the same time point (P _ (0.2) Pao _ (2) P _ (0.05)). There was a significant difference between the two groups before and after 5min, but there was no significant difference between the two groups after 5min. Conclusion: on the basis of optimal PEEP of small tidal volume and when the abdominal pressure basically returns to normal grade I abdominal pressure, lung reopening manipulation can be used in the treatment of SAP complicated with ARDS in good time, which is more beneficial to improve compliance and oxygenation than small tidal volume mechanical ventilation. Promote collapsed alveolar extension, shorten the course of SAP complicated with ARDS and reduce the incidence of VAP.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563.8;R576

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