摘要
目的比较重症脑卒中合并肺不张或呼吸窘迫综合征患者实施不同的肺复张处理的临床疗效与预后指标。方法前瞻性分析法将昆明市第三人民医院2017年10月至2019年10月收治的96例重症脑卒中合并呼吸窘迫综合征或肺不张的患者作为研究对象,采用分层随机方法分为对照组与实验组各48例。2组均行积极对症治疗,在此基础上对照组实施呼吸末正压递增性肺复张,实验组实施最佳动脉顺应性肺复张。对2组患者经不同肺复张处理后的临床疗效及预后指标进行比较分析。结果2组患者肺复张治疗后动脉血氧分压PaO_(2)、氧合指数PaO_(2)/FiO_(2)较治疗前有一定程度改变,实验组治疗后0.5h的PaO_(2)指标,治疗后1h的PaO_(2)、PaO_(2)/FiO_(2)指标均高于对照组,组间比较差异显著(P<0.05)。对照组肺复张治疗后的颅内压、脑灌注压指标较治疗前变化显著,而实验组治疗前后各指标更趋于稳定,与对照组治疗后比较有明显差异(P<0.05);治疗后实验组血清神经元特异性烯醇化酶NSE水平低于对照组(P<0.05)。实验组临床治疗总有效率(79.17%)高于对照组(60.42%),组间差异显著(χ^(2)=4.002,P=0.045)。2组28 d病死率、不良反应发生率比较无明显差异(P>0.05)。结论对于重症脑卒中合并肺不张或呼吸窘迫综合征患者,予以最佳动脉顺应性肺复张干预,对促进患者血流动力学指标稳定,改善脑组织损伤,降低预后不良事件发生有确切疗效,值得临床应用。
Objective To compare the clinical efficacy and prognosis of patients with severe stroke complicated with atelectasis or respiratory distress syndrome after different pulmonary reopening treatments.Methods We made a prospective analysis of 96 patients with severe stroke complicated with respiratory distress syndrome or atelectasis admitted to the Third People’s Hospital in Kunming from October 2017 to October 2019.The stratified randomized method was used to divide the patients into 2 groups:control group and experimental group with48 cases in each group.Both groups underwent active symptomatic treatment.On the basis of this,the control group was subjected to progressive end-expiratory pulmonary recruitment,and the experimental group was performed with compliant lung recruitment.The clinical efficacy and prognosis of the two groups of patients after different lung recruitment were compared and analyzed.Results PaO_(2),PaO_(2)/FiO_(2) indicators in the two groups of patients after lung recruitment were changed to some extent before treatment.The PaO_(2) index of 0.5 h after treatment in the experimental group and the PaO_(2) and PaO_(2)/FiO_(2) indexes at 1 h after treatment were higher than the control group.The difference was significant(P<0.05).The intracranial pressure and cerebral perfusion pressure index of the control group after lung recruitment were significantly different from those before treatment,while the indexes in the experimental group were more stable before and after treatment,and there was significant difference compared with the control group(P<0.05).The NSE level of the group was lower than that of the control group(P<0.05).The total effective rate of clinical treatment in the experimental group was(79.17%)higher than that in the control group(60.42%),and the difference between the groups was significant(χ^(2)=4.002,P=0.045).There was no significant difference in the mortality rate and adverse reaction rate between the two groups(P>0.05).Conclusion For patients with severe stroke complicated with atelectasis or respiratory distress syndrome,compliant lung recruitment intervention is effective in promoting stable hemodynamic parameters,improving brain tissue damage,and reducing prognosis.It is worthy of clinical application.
作者
沈凌筠
王戈
袁丽娟
SHEN Ling-jun;WANG Ge;YUAN Li-juan(Third Department of Tuberculosis,Third People's Hospital of Kunming,Kunming Yunnan 650041,China)
出处
《昆明医科大学学报》
CAS
2021年第10期162-166,共5页
Journal of Kunming Medical University
基金
昆明市医药卫生科技计划基金资助项目(2021-03-02-003)。
关键词
重症脑卒中
肺不张
呼吸窘迫
最佳动脉顺应性肺复张
Severe stroke
Atelectasis
Respiratory distress
Optimal arterial compliant pulmonary retraction
作者简介
沈凌筠(1982-),男,云南个旧人,管理学硕士,副主任医师,主要从事结核病临床与科研工作;通信作者:王戈,E-mail:986001983@qq.com。
