摘要
目的:探讨死腔分数(VD/VT)与俯卧位机械通气(PPV)下重症急性呼吸窘迫综合征(ARDS)患者预后的相关性。方法:收集2018年7月—2020年7月我院收治的60例重症ARDS患者的临床资料,并根据ARDS患者的发病因素将患者分为肺内源性病因组(32例)和肺外源性病因组(28例)。两组患者均予以PPV治疗,观察并比较两组患者的呼吸频率(RR)、心率(HR)、呼气末正压(PEEP)、中心静脉压(CVP)、平均动脉压(MAP)、肺损伤评分(LIS评分)、急性生理和慢性健康状况Ⅱ评分(APACHEⅡ评分)、不同时间点氧合指数(OI)与VD/VT的变化情况,并对60例ARDS患者OI与VD/VT的相关性进行分析。结果:(1)两组患者RR、HR、PEEP、CVP、MAP、LIS评分、APACHEⅡ评分比较,差异均无统计学意义(P>0.05)。(2)60例患者不同时间点OI呈上升趋势,差异有统计学意义(P<0.05);60例患者不同时间点VD/VT比较,差异有统计学意义(P<0.05)。(3)Pearson相关性分析结果显示,OI与VD/VT呈正相关(r=0.64,P<0.05)。(4)两组患者不同时间点OI与VD/VT的变化情况比较,差异均有统计学意义(P<0.05)。俯卧位2 h,肺外源性病因组OI高于肺内源性病因组(P<0.05);俯卧位8 h,肺外源性病因组OI低于肺内源性病因组(P<0.05)。俯卧位2 h,肺外源性病因组VD/VT低于肺内源性病因组(P<0.05);俯卧位4 h,肺外源性病因组VD/VT高于肺内源性病因组(P<0.05)。结论:相较于OI,VD/VT作为PPV下重症ARDS患者治疗效果评价指标具有更高的灵敏性,可为后期的治疗提供较好的参考依据。
Objective:This study is aimed to investigate the correlation between dead space fraction(VD/VT)and the prognosis of severe acute respiratory distress syndrome(ARDS)patients under prone position mechanical ventilation(PPV).Methods:Sixty severe ARDS patients admitted to our hospital from July 2018 to July 2020 were collected as the observation subjects,and the patients were divided into two groups based on the incidence factors of ARDS:pulmonary endogenous disease group(32 cases)and pulmonary exogenous disease group(28 cases).Both groups of patients were treated with PPV,and their general conditions including respiratory rate(RR),heart rate(HR),positive end-expiratory pressure(PEEP),central venous pressure(CVP),mean arterial pressure(MAP),lung injury score(LIS score),acute physiological and chronic health statusⅡscore(APACHEⅡscore),oxygenation index(OI)and VD/VT changes at different time points were observed and compared.The correlation between OI and VD/VT in 60 ARDS patients was analyzed.Results:①There was no statistically significant difference in RR,HR,PEEP,CVP,MAP,LIS score,Or APACHEⅡscore between the two groups of patients(P>0.05).②The OI of 60 patients showed an upward trend at different time points,and the difference was statistically significant(P<0.05);There was a statistically significant difference(P<0.05)in VD/VT among 60 patients at different time points.③The Pearson correlation analysis showed a positive correlation between OI and VD/VT(r=0.64,P<0.05).④The changes in OI and VD/VT between two groups of patients at different time points were compared,and the differences were statistically significant(P<0.05).Lying prone for 2 hours,the OI of the group with exogenous pulmonary pathogens was higher than that of the group with endogenous pulmonary pathogens(P<0.05);Lying in a prone position for 8 hours,the OI of the exogenous pulmonary disease group was lower than that of the endogenous pulmonary disease group(P<0.05);Lying prone for 2 hours,the VD/VT of the group with exogenous pulmonary causes was lower than that of the group with endogenous pulmonary causes(P<0.05);Lying prone for 4 hours,the VD/VT of the group with exogenous pulmonary causes was higher than that of the group with endogenous pulmonary causes(P<0.05).Conclusion:Compared with OI,VD/VT has higher sensitivity as an evaluation index for the treatment effect of severe ARDS patients under going PPV,which can provide better reference for later treatment.
作者
韩明
瓦永禄
胡潇
虎娜
HAN Ming;WA Yonglu;HU Xiao;HU Na(Qinghai Red Cross Hospital,810000)
出处
《青海医药杂志》
2025年第3期1-5,共5页
Qinghai Medical Journal
关键词
死腔分数
俯卧位机械通气
重症急性呼吸窘迫综合征
预后
Dead space fraction
Prone position mechanical ventilation
Severe acute respiratory distress syndrome
Prognosis
