甲强龙联合无创正压通气治疗ARDS 100例的临床研究
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摘要
目的探讨甲强龙联合无创正压通气治疗ARDS的临床疗效。方法研究对象为2014年1月~2016年1月于我院重症医学科住院治疗的ARDS患者100例,所有患者均行综合治疗,纠正水和电解质紊乱及酸碱失衡,糖皮质激素甲强龙80 mg/次,2次/d,连用3~5 d,同时行NIPPV治疗。采用美国伟康生产的Bi PAP vision呼吸机,采用面罩进行人机连接。观察患者治疗后1 h、24 h、3 d、7 d的PaO_2/FiO_2、PaO_2、PaCO_2及RR等指标情况;观察患者的撤机成功率、呼吸机相关性肺炎、院内死亡情况。结果 100例ARDS患者甲强龙联合无创正压通气治疗后,显效55例,有效42例,无效3例,总有效率达97%。住院天数(12.6±2.3)d,撤机成功率100%,发生呼吸机相关性肺炎2例(2%),院内死亡1例(1%),死于呼吸衰竭。治疗后1 h、24 h、3 d、7 d,100例ARDS患者的PaO_2/FiO_2、PaO_2、Pa CO2及RR均较治疗前明显改善,差异有统计学意义(P<0.05)。结论甲强龙联合无创正压通气治疗ARDS疗效确切、住院时间短、并发症少,可显著改善患者的通气功能,缓解患者的临床症状,值得推广和应用。
Objective To explore the clinical efficacy of methylprednisolone combined with noninvasive positive pressure ventilation in the treatment of ARDS. Methods A total of 100 cases of ARDS treated in the Department of Intensive Care Unit in our hospital from January 2014 to January 2016 were selected as the study subjects. All patients underwent comprehensive treatment to correct water and electrolyte imbalance and acid-base imbalance, methylprednisolone 80 mg/time, 2 times/d for 3-5 days, and NIPPV treatment. Bi PAP vision ventilator produced in Wei Kang of the United States was used, and the mask was used for man-machine connection. The levels of PaO_2/FiO_2, PaO_2, PaCO_2 and RR at 1 h, 24 h, 3 d and 7 d after treatment, the success rate of weaning, ventilator-associated pneumonia and hospital deaths were observed. Results In 100 cases of ARDS patients after methylprednisolone combined with NPPV treatment, 55 cases were cured, 42 cases were effective, 3 cases were invalid, with the total effective rate of 97%. The length of hospital stay was(12.6±2.3) d. The success rate of weaning was 100%. Ventilator-associated pneumonia occurred in 2 cases(2%), and 1 case(1%) died in hospital whodied of respiratory failure. The PaO_2/FiO_2, PaO_2, Pa CO2 and RR were significantly improved in the patients with ARDS at 1 h, 24 h, 3 d, 7 d after treatment compared with those before treatment, and the difference was significant(P<0.05). Conclusion The combination of methylprednisolone and noninvasive positive pressure ventilation is effective in the treatment of ARDS, with short hospitalization time and fewer complications, which can significantly improve the ventilation function of patients and relieve the clinical symptoms of patients. It is worthy of promotion and application.
Objective To explore the clinical efficacy of methylprednisolone combined with noninvasive positive pressure ventilation in the treatment of ARDS. Methods A total of 100 cases of ARDS treated in the Department of Intensive Care Unit in our hospital from January 2014 to January 2016 were selected as the study subjects. All patients underwent comprehensive treatment to correct water and electrolyte imbalance and acid-base imbalance, methylprednisolone 80 mg/time, 2 times/d for 3-5 days, and NIPPV treatment. Bi PAP vision ventilator produced in Wei Kang of the United States was used, and the mask was used for man-machine connection. The levels of PaO_2/FiO_2, PaO_2, PaCO_2 and RR at 1 h, 24 h, 3 d and 7 d after treatment, the success rate of weaning, ventilator-associated pneumonia and hospital deaths were observed. Results In 100 cases of ARDS patients after methylprednisolone combined with NPPV treatment, 55 cases were cured, 42 cases were effective, 3 cases were invalid, with the total effective rate of 97%. The length of hospital stay was(12.6±2.3) d. The success rate of weaning was 100%. Ventilator-associated pneumonia occurred in 2 cases(2%), and 1 case(1%) died in hospital whodied of respiratory failure. The PaO_2/FiO_2, PaO_2, Pa CO2 and RR were significantly improved in the patients with ARDS at 1 h, 24 h, 3 d, 7 d after treatment compared with those before treatment, and the difference was significant(P<0.05). Conclusion The combination of methylprednisolone and noninvasive positive pressure ventilation is effective in the treatment of ARDS, with short hospitalization time and fewer complications, which can significantly improve the ventilation function of patients and relieve the clinical symptoms of patients. It is worthy of promotion and application.
引文
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[15]古满平,丁福,范晶.无创正压通气在多发伤并发ALI/ARDS中的临床应用[J].重庆医科大学学报,2010,35(12):1884-1886.
[16]王玲,杨敬平,徐喜嫒,等.无创正压通气在早期ARDS中的应用体会[J].内蒙古医学杂志,2008,40(11):1339-1340.
[17]刘澄英,谢伟国.急性呼吸窘迫综合征患者无创通气和预后的影响因素分析[J].中国地方病防治杂志,2016,31(10):1164-1665.
[18]江勇,付印强,王金宝,等.急性呼吸窘迫综合征早期应用无创正压通气的效果观察[J].中国医学创新,2013,10(11):25-26.
[19]房晓薇.糖皮质激素治疗急性呼吸窘迫综合征(ARDS)的系统评价[D].南昌大学,2015.
[20]许红阳,姜淑云,臧芝栋,等.糖皮质激素对早期ARDS患者的治疗效果[J].江苏医药,2014,40(21):2618-2619.
[2]昝海峰,徐智,杨恂.无创正压通气治疗急性呼吸窘迫综合征的疗效观察[J].四川医学,2009,30(2):201-202.
[3]刘延媛,夏家惠,叶初阳.无创正压通气治疗急性呼吸窘迫综合征早期的临床分析[J].实用心脑肺血管病杂志,2010,18(5):547-548.
[4]尉玉杰,王慕,井慎,等.无创正压通气治疗轻度急性呼吸窘迫综合征的临床观察[J].内科急危重症杂志,2015,21(4):289-290.
[5]宁美玲.无创正压通气在呼吸系疾病中的研究迸展[D].蚌埠医学院,2015.
[6]张文平,马利军.无创正压通气治疗急性肺损伤/急性呼吸窘迫综合征研究进展[J].内科急危重症杂志,2011,17(1):239-240.
[7]吴杰斌,周彬,翟敬芳,等.不同无创通气模式联合肺表面活性物质在新生儿呼吸窘迫综合征初始呼吸支持的临床应用[J].中华临床医师杂志(电子版),2017,11(3):383-384.
[8]Meneses J,Bhandari V,Alves JG.Nasal intermittent positive-pressure ventilation vs nasal continuous positive airway pressure for preterm infants with respiratory distress syndrome:A systematic review and meta-analysis[J].Arch Pediatr Adolesc Med,2012,166(4):372-376
[9]Sweet DG,Carnielli V,Greisen G,et al.European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-2013 update[J].Neonatology,2013,103(4):353-368.
[10]中华医学会重症医学会.急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)[J].中国实用外科杂志,2006,27:3-6.
[11]吴玉华,潘尉.双水平无创正压通气治疗急性呼吸窘迫综合征26例临床观察[J].中国社区医师·医学专业,2011,13(15):138-140.
[12]王黑豆,姚少侠,李燕平,等.无创正压通气治疗肾综合征出血热合并急性呼吸窘迫综合征疗效观察[J].现代中西医结合杂志,2013,22(34):3789-3790.
[13]中华医学会呼吸病学分会.急性肺损伤/急性呼吸窘迫综合征的诊断标准(草案)[J].中华结核和呼吸杂志,2000,23(3):203-205.
[14]蓝必万.无创通气联合药物治疗成人急性呼吸窘迫综合征效果研究[J].中外医学研究,2015,13(19):55-56.
[15]古满平,丁福,范晶.无创正压通气在多发伤并发ALI/ARDS中的临床应用[J].重庆医科大学学报,2010,35(12):1884-1886.
[16]王玲,杨敬平,徐喜嫒,等.无创正压通气在早期ARDS中的应用体会[J].内蒙古医学杂志,2008,40(11):1339-1340.
[17]刘澄英,谢伟国.急性呼吸窘迫综合征患者无创通气和预后的影响因素分析[J].中国地方病防治杂志,2016,31(10):1164-1665.
[18]江勇,付印强,王金宝,等.急性呼吸窘迫综合征早期应用无创正压通气的效果观察[J].中国医学创新,2013,10(11):25-26.
[19]房晓薇.糖皮质激素治疗急性呼吸窘迫综合征(ARDS)的系统评价[D].南昌大学,2015.
[20]许红阳,姜淑云,臧芝栋,等.糖皮质激素对早期ARDS患者的治疗效果[J].江苏医药,2014,40(21):2618-2619.