摘要
目的探讨两种同期联合吸入一氧化氮(NO)治疗重度急性呼吸窘迫综合征(ARDS)致难治性呼吸衰竭的临床疗效。方法选取于2015年1月至2016年7月医院收治的86例重度ARDS患者作为研究对象,根据随机数字表法将患者分成观察组和对照组,每组各43例,观察组患者采用高频振荡通气(HFOV)治疗,对照组采用常频机械通气(CMV),二组均联合NO吸入治疗,两组均治疗24 h后,观察并记录两组患者临床疗效、治疗前后动脉血氧分压(PaO_2)、二氧化碳分压(PaCO_2)、吸入氧浓度(FiO_2)、血氧饱和度(SpO_2)等肺功能指标变化情况以及并发症发生情况,并进行分析比较。结果观察组显效患者27例,总有效率95.35%;对照组显效患者29例,总有效率97.67%,两组比较差异无统计学意义(P<0.05)。两组患者治疗24 h后PaO_2、PaCO_2、FiO_2以及SpO_2等肺功能指标均较治疗前有明显改善;对照组患者PaO_2改善较为明显,观察组PaCO_2改善更明显,两组比较差异有统计学意义(P<0.05);治疗24 h后,两组患者FiO_2和SpO_2无明显统计学差异(P>0.05)。观察组患者并发症发生率为18.60%,对照组并发症发生率稍低,约为16.28%,两组比较差异无统计学意义(P>0.05)。结论采用HFOV或CMV联合吸入NO治疗重度ARDS致难治性呼吸衰竭患者临床疗效均较好,并发症发生概率也无明显差异。患者以高碳酸血症为主时,采用HFOV治疗对PaCO_2改善效果更好;而以氧合不好为主要临床症状的患者,采用CMV联合吸入NO对PaO_2改善效果更佳,临床上应灵活选用治疗方式。
Objective To investigate the clinical efficacy of two simultaneous inhaled nitric oxide(NO)in the treatment of severe acute respiratory distress syndrome(ARDS)refractory respiratory failure.Methods All of 86 cases of severe ARDS patients were selected from January 2015 to July 2016 in our hospital,they were randomly divided into observation group(43 cases)and control group(43 cases),the observation group were treated with high frequency oscillatory ventilation(HFOV)treatment,the control group using conventional mechanical ventilation(CMV)combined with NO inhalation therapy,two groups after 24 h treatment,the clinical efficacy were observed and recorded in the two groups before and after treatment,arterial oxygen pressure(PaO 2),carbon dioxide partial pressure(PaCO 2),inhaled oxygen concentration(FiO 2),oxygen saturation(SpO 2),lung function The change of the standard and complications were analyzed and compared.Results The total effective rate was 95.35%in the observation group and 29.6%in the control group.The total effective rate was 97.67%.There was no significant difference between the two groups(P<0.05).PaO 2,PaO 2,FiO 2,SpO 2 and other lung function indicators were significantly improved before treatment;PaO 2 in the control group were improved significantly,the observation group PaCO 2 was improved more significantly,the two groups were statistically significant(P<0.05).There was no significant difference in FiO 2 and SpO 2 between the two groups(P>0.05).The incidence of complication was 18.60%in the observation group and 16.28%in the control group.There was no statistically significant difference between the two groups(P>0.05).Conclusions The combination of HFOV or CMV combined with NO in the treatment of severe ARDS refractory respiratory failure in patients with clinical efficacy are good,the incidence of complications and no significant difference.Patients with hypercapnia,the use of HFOV treatment to improve the effectiveness of PaCO 2 better;and poor oxygenation as the main clinical symptoms of patients with CMV combined with inhalation of NO on PaO 2 to improve the effect of better clinical selection should be flexible treatment.
作者
杜燕芳
黄国华
徐小彭
古辉
李雪平
Du Yafang;Huang Guohua;Xu Xiaopeng;Gu Hui;Li Xueping(Department of Respiratory Medicine,Peoples′Hospital of Gaoming District,of Foshan City of Guangdong Province,Foshan 528500,China)
出处
《中华肺部疾病杂志（电子版）》
CAS
2018年第1期82-85,共4页
Chinese Journal of Lung Diseases(Electronic Edition)
基金
广东省医学科研基金资助项目(A20153214)
关键词
呼吸窘迫综合征
高频振荡通气
呼吸衰竭
吸入一氧化氮
ARDS Respiratory distress syndrome
High frequency oscillatory ventilation
Respiratory failure
Inhaled nitric oxide
