俯卧位通气对创伤后急性呼吸窘迫综合征的临床救治价值

摘要

Objective To evaluate the clinical treatment value of prone position ventilation(PPV) in post-traumatic acute respiratory distress syndrome (ARDS).Methods The post-traumatic ARDS patients treated in ICU of our hospital from January 1,2014 to December 31,2015 were retrospectively analyzed.The patients were divided into PPV group and non-PPV group according to whether conducting PPV.The demographic data and clinical data (age,gender,APACHEⅡ,SOFA score,number of underlying diseases),trauma related AIS and ISS scores,oxygenation indexes on 0,1,3,7,14 d after PPV,prognostic indicators (ventilator use time,retaining canal time,ICU stay length,total hospitalization duration,mortalities on 28,90 d).Results There was no statistic difference in demography data and clinical data between the two groups,and so did the oxygenation index (OI) on 0 d.OI on 1,3,7,14 d in the PPV group were 173.5±68.9,294.7±116.2,324.4±123.2 and 367.9±147.4 respectively,while which in the non-PPV group were 134.5±58.2,163.7±68.4,176.3±77.2 and 182.1±83.4,which in the PPV group were higher than those in the non-PPV group,the differences were statistically significant(P<0.05);the ventilator use time in the non-PPV group and PPV group were (24.4±11.1)d and (16.7±6.8)d respectively,the difference was statistically significant(P<0.05).The ICU stay time in the non-PPV group and PPV group were (34.1±14.7)d and (25.0±11.6)d respectively,the difference was statistically significant(P<0.05).The 90 d mortality rates in the non-PPV group and PPV group were 41.9% and 18.2% respectively,the difference was statistically significant(P<0.05).Conclusion PPV can improve OI in post-traumatic ARDS patients,reduces the ventilator use time,decreases the ICU stay time and declines the 90 d mortality.%目的 评估俯卧位通气对创伤后急性呼吸窘迫综合征(ARDS)的临床救治价值.方法 回顾性分析2014年1月1日至2015年12月31日第三军医大学第三附属医院重症医学科ICU收治的创伤后ARDS患者,按照是否行俯卧位通气分为俯卧位通气组和非俯卧位通气组.记录人口学资料和临床资料(年龄、性别、急性生理功能和慢性健康状况评分系统Ⅱ、序贯器官衰竭估计评分、基础疾病数量),创伤相关的损伤严重度评分和简明创伤评分,采集俯卧位通气治疗后第0、1、3、7、14天氧合指数,预后指标(呼吸机使用时间、带管时间、ICU住院时间、总的住院时间,28 d和90 d的病死率).结果 两组患者人口学资料和临床资料之间差异无统计学意义(P>0.05);俯卧位通气治疗后第0天的氧合指数差异无统计学意义(P>0.05);俯卧位通气组第1、3、7、14天的氧合指数分别为173.5±68.9、294.7±116.2、324.4±123.2、367.9±147.4,非俯卧位通气组第1、3、7、14天的氧合指数分别为134.5±58.2、163.7±68.4、176.3±77.2、182.1±83.4,俯卧位通气组第1、3、7、14天氧合指数高于非俯卧位组第1、3、7、14天的氧合指数,差异有统计学意义(P<0.05);非俯卧位通气组和俯卧位通气组呼吸机使用时间分别为(24.4±11.1)d、(16.7±6.8)d,差异有统计学意义(P<0.05).非俯卧位通气组和俯卧位通气组ICU住院时间分别为(34.1±14.7)d、(25.0±11.6)d,差异有统计学意义(P<0.05).非俯卧位通气组和俯卧位通气组90 d病死率分别为41.9%和18.2%,差异有统计学意义(P<0.05).结论 俯卧位通气能够改善创伤后ARDS患者的氧合指数,减少呼吸机使用时间,减少ICU住院时间,降低90 d病死率.