不同俯卧位通气时间对中重度肺内/外源性ARDS患者的治疗效果

目的:探讨中重度肺内/外源性ARDS患者行不同时间俯卧位通气的治疗效果。方法:将中重度30例肺内/30例外源性ARDS患者分别行2h、4h俯卧位通气,观察患者APCHEII评分,氧合指数、胸片吸收情况、心率、平均动脉压、脱机拔管时间,出ICU时间。结果:四组患者APCHEII评分、心率、平均动脉压比较差异均无统计学意义(P0.05)。肺内源性ARDS患者行2 h、4 h俯卧位通气均能有效改善患者氧合指数,4 h组较2 h组氧合指数改善、胸片吸收情况更明显,4 h组在脱机时间、转出ICU时间均优于2 h组(P0.05);肺外源性ARDS患者行2 h、4 h俯卧位通气均能有效改善患者各项指标,但两组间无统计学差异(P0.05),且均优于肺内源性ARDS患者(P0.05)。结论:俯卧位通气可改善中重度肺内/外源性ARDS患者的病情,其对肺外源性ARDS患者效果更好,2 h俯卧位通气即能取得较好效果,而肺内源性ARDS患者需更长时间的俯卧位通气改善病情且预后较差。

Clinical Effect of Different Ventilation Time at Prone Position on the Patients with Endogenous/Exogenous ARDS

ABSTRACT Objective: To investigate the effect of different ventilation time in the prone position on patients with endogenous/exogenous ARDS. Methods: 30 endogenous/ 30 exogenous ARDS patients were randomly devided into 4 groups, ventilation in the prone position for 2 h and 4 h. Recording the score of APCHEII, oxygenation index, the absorption situation in X-ray, HR, MAP, extubation time, the time out of ICU. Results: The APCHEII scores HR and MAP in four groups have no significant statistics (P>0.05); 4 h ventilation for endogenous ARDS patients has a better indicators than 2 h in oxygenation index, the absorption situation in X-ray, extubation time and the time out of ICU(P<0.05); 2 h and 4 h ventilation for exogenous ARDS patients can improve indicators above, two groups have no significant statistics (P>0.05), the results of exogenous groups are precede than endogenous group(P<0.05). Conclusion: Ventilation in the prone position can improve the situation of ARDS patients, both endogenous patients and exogenous patients. Exogenous ARDS patients have a better treatment effect after the ventilation of 2h, however, endogenous patients need longer time and have a non-ideal prognosis.