俯卧位通气治疗急性百草枯中毒致中重度急性呼吸窘迫综合征的临床研究
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摘要
目的俯卧位通气是治疗急性肺损伤/急性呼吸窘迫综合征(ARDS)的重要方法之一,目前俯卧位通气治疗急性百草枯中毒导致ARDS的报道较少。文中旨在评价俯卧位通气治疗急性百草枯中毒致中重度ARDS的价值。方法回顾性分析2016年1月至2017年12月东部战区总医院急救医学科43例急性百草枯中毒合并中重度ARDS患者的临床资料。以是否行俯卧位通气将患者分为2组:俯卧组(进行俯卧位通气,n=13)、对照组(未进行俯卧位通气,n=30)。统计分析2组患者入科时的性别、年龄、APACHE II评分、血浆百草枯浓度等指标,比较住院前5天的氧合指数、呼吸频率、二氧化碳分压及平均动脉压,同时比较2组患者住院病死率、住院时间、机械通气时间等预后指标。结果第2天,俯卧组患者氧合指数(176±13)、二氧化碳分压[(33.6±4.3) mm Hg]较对照组[(149±18)、(26.3±3.2) mm Hg]明显升高(P<0.05),第3-5天亦明显升高(P<0.05);俯卧组呼吸频率较对照组明显降低(P<0.05)。2组患者的住院病死率、住院时间、机械通气时间、气道意外率等差异均无统计学意义(P>0.05)。结论俯卧位通气用于急性百草枯中毒致中重度ARDS的患者是安全的,改善了该类患者的氧合,但未能改善预后。为俯卧位通气治疗急性百草枯中毒合并ARDS提供了理论依据。
Objective Prone position ventilation is one of the most important methods for the treatment of acute lung injury/acute respiratory distress syndrome( ARDS). Currently,there are fewer researches on prone position ventilation for ARDS caused by acute paraquat poisoning. This article aims to evaluate the value of prone position ventilation in the treatment of moderate and severe ARDS caused by acute paraquat poisoning. Methods Retrospective analysis the clinical data of 43 patients with acute paraquat poisoning complicated with moderate-to-severe ARDS from January 2016 to December 2017 in the Department of Emergency Medicine,Eastern Theater of the Eastern Theater. The patients were divided into two groups according to whether they were in prone position ventilation: experimental group( prone position ventilation,n = 13) and control group( no prone position ventilation,n = 30). The gender,age,APACHEII score and plasma paraquat concentration of the two groups were statistically analyzed. The oxygenation index,respiratory rate,carbon dioxide partial pressure and mean arterial pressure were compared between the two groups during the first five days after hospitalization. At the same time,the hospital mortality,hospitalization time,mechanical ventilation time were also compared.Results Compared with control group,the oxygenation index( 176±13) and carbon dioxide partial pressure [( 33.6±4.3) mm Hg] in the experimental group were significantly increased from the 2 nd day to5 th day after hospitalization( P < 0. 05),but the respiratory rate was significantly decreased( P < 0. 05). There were no significant differences in hospital mortality,hospitalization time,mechanical ventilation time,and airway accident rate between the two groups( P >0.05). Conclusion Prone position ventilation is safe for patients with moderate to severe ARDS caused by acute paraquat poisoning,which improves oxygenation in these patients but fails to improve prognosis. It provides a theoretical basis for prone position ventilation in the treatment of acute paraquat poisoning complicated with ARDS.
Objective Prone position ventilation is one of the most important methods for the treatment of acute lung injury/acute respiratory distress syndrome( ARDS). Currently,there are fewer researches on prone position ventilation for ARDS caused by acute paraquat poisoning. This article aims to evaluate the value of prone position ventilation in the treatment of moderate and severe ARDS caused by acute paraquat poisoning. Methods Retrospective analysis the clinical data of 43 patients with acute paraquat poisoning complicated with moderate-to-severe ARDS from January 2016 to December 2017 in the Department of Emergency Medicine,Eastern Theater of the Eastern Theater. The patients were divided into two groups according to whether they were in prone position ventilation: experimental group( prone position ventilation,n = 13) and control group( no prone position ventilation,n = 30). The gender,age,APACHEII score and plasma paraquat concentration of the two groups were statistically analyzed. The oxygenation index,respiratory rate,carbon dioxide partial pressure and mean arterial pressure were compared between the two groups during the first five days after hospitalization. At the same time,the hospital mortality,hospitalization time,mechanical ventilation time were also compared.Results Compared with control group,the oxygenation index( 176±13) and carbon dioxide partial pressure [( 33.6±4.3) mm Hg] in the experimental group were significantly increased from the 2 nd day to5 th day after hospitalization( P < 0. 05),but the respiratory rate was significantly decreased( P < 0. 05). There were no significant differences in hospital mortality,hospitalization time,mechanical ventilation time,and airway accident rate between the two groups( P >0.05). Conclusion Prone position ventilation is safe for patients with moderate to severe ARDS caused by acute paraquat poisoning,which improves oxygenation in these patients but fails to improve prognosis. It provides a theoretical basis for prone position ventilation in the treatment of acute paraquat poisoning complicated with ARDS.
引文
[1]姚冬奇,李敏,郝树亭,等.急性百草枯中毒长期存活患者肺损伤研究[J].中国急救医学,2016,36(6):517-520.
[2]张文武.急性百草枯中毒的国内诊治进展[J].中华危重病急救医学,2015,4:242-243.
[3]Scholten EL,Beitler JR,Prisk GK,et al.Treatment of Acute Respiratory Distress Syndrome with Prone Positioning[J].Chest,2016,151(1):215-224.
[4]Iftikhar IH,Donley MA,Owens WB,et al.Prone positioning in acute respiratory distress syndrome[J].Crit Care Med,2015,43(2):55-56.
[5]中国医师协会急诊医师分会.急性百草枯中毒诊治专家共识(2013)[J].中国急救医学,2013,33(6):484-489.
[6]Ranieri VM,Rubenfeld GD,Thompson BT,et al.Acute respiratory distress syndrome:the Berlin Definition[J].JAMA,2012,307(23):2526.
[7]Lee Y,Lee JH,Seong AJ,et al.Arterial lactate as a predictor of mortality in emergency department patients with paraquat intoxication[J].Clin Toxicol,2012,50(1):52-56.
[8]焦峰军,祝文,王涛宁,等.急性百草枯中毒患者预后危险因素分析[J].中华危重病急救医学,2015,27(11):906-910.
[9]Long Y,Zeng J,Jiang Q.Pathogenesis and therapies of lung injury caused by acute Paraquatpoisoning[J].China Med Her,2011,30(11):811-815.
[10]Kim SH,Park IN.Acute Respiratory Distress Syndrome as the Initial Clinical Manifestation of an Antisynthetase Syndrome[J].Tuberc Respir Dis(Seoul),2016,79(3):188-192.
[11]刘笑雷,张国强.俯卧位通气治疗急性呼吸窘迫综合征研究进展[J].实用医院临床杂志,2012,9(1):15-18.
[12]Mora-Arteaga JA,Bernal-Ramírez OJ,Rodríguez SJ.The effects of prone position ventilation in patients with acute respiratory distress syndrome.A systematic review and metaanalysis[J].Med Intensiva,2015,39(6):359-372.
[13]Schmidt M,Stewart C,Bailey M,et al.Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome:a retrospective international multicenter study[J].Crit Care Med,2015,43(3):654-664.
[14]Chen X,Tang H,Zhou J,et al.Clinical treatment value of prone position ventilation in post-traumatic acute respiratory distress syndrome[J].Lab Med Clin,2017,14(11):1525-1527.
[15]彭菲菲,邵强,赵宁,等.MCC950对线粒体损伤相关分子模式诱导大鼠肺损伤的保护作用[J].医学研究生学报,2017,30(11):1166-1171.
[16]Agrawal SP,Goel AD.Prone position ventilation in Acute Respiratory Distress Syndrome:An overview of the evidences[J].Indian J Anaesth,2015,59(4):246-248.
[17]孙兆瑞,赵扬,杨志洲,等.抑制Wnt/β-catenin信号通路对百草枯致肺纤维化影响的研究[J].医学研究生学报,2017,30(2):117-121.
[18]Kwee MM,Ho YH,Rozen WM.The Prone Position During Surgery and its Complications:A Systematic Review and EvidenceBased Guidelines[J].Int Srg,2015,100(2):292.
[2]张文武.急性百草枯中毒的国内诊治进展[J].中华危重病急救医学,2015,4:242-243.
[3]Scholten EL,Beitler JR,Prisk GK,et al.Treatment of Acute Respiratory Distress Syndrome with Prone Positioning[J].Chest,2016,151(1):215-224.
[4]Iftikhar IH,Donley MA,Owens WB,et al.Prone positioning in acute respiratory distress syndrome[J].Crit Care Med,2015,43(2):55-56.
[5]中国医师协会急诊医师分会.急性百草枯中毒诊治专家共识(2013)[J].中国急救医学,2013,33(6):484-489.
[6]Ranieri VM,Rubenfeld GD,Thompson BT,et al.Acute respiratory distress syndrome:the Berlin Definition[J].JAMA,2012,307(23):2526.
[7]Lee Y,Lee JH,Seong AJ,et al.Arterial lactate as a predictor of mortality in emergency department patients with paraquat intoxication[J].Clin Toxicol,2012,50(1):52-56.
[8]焦峰军,祝文,王涛宁,等.急性百草枯中毒患者预后危险因素分析[J].中华危重病急救医学,2015,27(11):906-910.
[9]Long Y,Zeng J,Jiang Q.Pathogenesis and therapies of lung injury caused by acute Paraquatpoisoning[J].China Med Her,2011,30(11):811-815.
[10]Kim SH,Park IN.Acute Respiratory Distress Syndrome as the Initial Clinical Manifestation of an Antisynthetase Syndrome[J].Tuberc Respir Dis(Seoul),2016,79(3):188-192.
[11]刘笑雷,张国强.俯卧位通气治疗急性呼吸窘迫综合征研究进展[J].实用医院临床杂志,2012,9(1):15-18.
[12]Mora-Arteaga JA,Bernal-Ramírez OJ,Rodríguez SJ.The effects of prone position ventilation in patients with acute respiratory distress syndrome.A systematic review and metaanalysis[J].Med Intensiva,2015,39(6):359-372.
[13]Schmidt M,Stewart C,Bailey M,et al.Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome:a retrospective international multicenter study[J].Crit Care Med,2015,43(3):654-664.
[14]Chen X,Tang H,Zhou J,et al.Clinical treatment value of prone position ventilation in post-traumatic acute respiratory distress syndrome[J].Lab Med Clin,2017,14(11):1525-1527.
[15]彭菲菲,邵强,赵宁,等.MCC950对线粒体损伤相关分子模式诱导大鼠肺损伤的保护作用[J].医学研究生学报,2017,30(11):1166-1171.
[16]Agrawal SP,Goel AD.Prone position ventilation in Acute Respiratory Distress Syndrome:An overview of the evidences[J].Indian J Anaesth,2015,59(4):246-248.
[17]孙兆瑞,赵扬,杨志洲,等.抑制Wnt/β-catenin信号通路对百草枯致肺纤维化影响的研究[J].医学研究生学报,2017,30(2):117-121.
[18]Kwee MM,Ho YH,Rozen WM.The Prone Position During Surgery and its Complications:A Systematic Review and EvidenceBased Guidelines[J].Int Srg,2015,100(2):292.