俯卧位通气治疗脓毒症诱发的急性呼吸窘迫综合征的临床评估
Clinical evaluation of prone position ventilation in the treatment of acute respiratory distress syndrome induced by sepsis.
作者信息
Xia Wen-Han, Yang Chun-Li, Chen Zhi, Ouyang Cheng-Hong, Ouyang Guo-Quan, Li Qiu-Gen
机构信息
Department of Intensive Care Unit, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China.
Department of Emergency, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China.
出版信息
World J Clin Cases. 2022 Jun 16;10(17):5577-5585. doi: 10.12998/wjcc.v10.i17.5577.
BACKGROUND
Acute respiratory distress syndrome (ARDS) is an acute, diffuse, inflammatory lung injury. Previous studies have shown prone position ventilation (PPV) to be associated with improvement in oxygenation. However, its role in patients with ARDS caused by sepsis remains unknown.
AIM
To analyze the clinical effects of PPV in patients with ARDS caused by sepsis.
METHODS
One hundred and two patients with ARDS were identified and divided into a control group ( = 55) and a PPV treatment group ( = 47). Outcomes included oxygenation index, lung compliance (Cst) and platform pressure (Pplat), which were compared between the two groups after ventilation. Other outcomes included heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), left ventricular ejection fraction (LVEF), the length of mechanical ventilation time and intensive care unit (ICU) stay, and levels of C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) after ventilation. Finally, mortality rate was also compared between the two groups.
RESULTS
On the first day after ventilation, the oxygenation index and Cst were higher and Pplat level was lower in the PPV group than in the conventional treatment group ( < 0.05). There were no significant differences in oxygenation index, Cst, and Pplat levels between the two groups on the 2, 4, and 7 day after ventilation ( > 0.05). There were no significant differences in HR, MAP, CVP, LVEF, duration of mechanical ventilation and ICU stay, and the levels of CRP, PCT, and IL-6 between the two groups on the first day after ventilation (all > 0.05). The mortality rates on days 28 and 90 in the PPV and control groups were 12.77% and 29.09%, and 25.53% and 45.45%, respectively ( < 0.05).
CONCLUSION
PPV may improve respiratory mechanics indices and may also have mortality benefit in patients with ARDS caused by sepsis. Finally, PPV was not shown to cause any adverse effects on hemodynamics and inflammation indices.
背景
急性呼吸窘迫综合征（ARDS）是一种急性、弥漫性炎症性肺损伤。既往研究表明，俯卧位通气（PPV）与氧合改善相关。然而，其在脓毒症所致ARDS患者中的作用仍不明确。
目的
分析PPV对脓毒症所致ARDS患者的临床效果。
方法
纳入102例ARDS患者，分为对照组（n = 55）和PPV治疗组（n = 47）。观察指标包括氧合指数、肺顺应性（Cst）和平台压（Pplat），通气后比较两组上述指标。其他观察指标包括心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、左心室射血分数（LVEF）、机械通气时间和重症监护病房（ICU）住院时间，以及通气后C反应蛋白（CRP）、降钙素原（PCT）和白细胞介素-6（IL-6）水平。最后，比较两组的死亡率。
结果
通气后第1天，PPV组的氧合指数和Cst高于传统治疗组，Pplat水平低于传统治疗组（P < 0.05）。通气后第2、4和7天，两组的氧合指数、Cst和Pplat水平差异无统计学意义（P > 0.05）。通气后第1天，两组的HR、MAP、CVP、LVEF、机械通气时间和ICU住院时间，以及CRP、PCT和IL-6水平差异均无统计学意义（均P > 0.05）。PPV组和对照组第28天和第90天的死亡率分别为12.77%和29.09%，以及25.53%和45.45%（P < 0.05）。
结论
PPV可能改善脓毒症所致ARDS患者的呼吸力学指标，并可能对死亡率有益。最后，未显示PPV对血流动力学和炎症指标有任何不良影响。
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