个体化治疗方案在急性呼吸窘迫综合征中应用的效果及对呼吸及循环指数、血清炎症因子的影响
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摘要
目的观察急性呼吸窘迫综合征(ARDS)个体化治疗的疗效,并评价其临床应用价值。方法选择ARDS患者80例,随机分为研究组和对照组,各40例,分别给予个体化治疗和常规治疗,比较2组的治疗情况及预后。结果研究组治疗后的心率(HR)、平均动脉压(MAP)、氧合指数(OI)及呼吸指数(RI)均较治疗前显著改善(P<0.05),其中HR、OI及RI的改善情况明显优于对照组(P<0.05);研究组治疗后的血清超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)及白细胞介素-1β(IL-1β)水平均较治疗前显著降低(P<0.05),且均明显低于对照组治疗后(P<0.05);与对照组比,研究组的机械通气时间、ICU住院时间均较短,呼吸机相关性肺炎(VAP)发生率及病死率均较低,组间差异有统计学意义(P<0.05)。结论 ARDS个体化治疗可有效改善患者的肺氧合功能,减轻炎症,缩短机械通气时间并改善预后,临床应用价值较高。
Objective To observe the efficacy of individualized therapy for acute respiratory distress syndrome( ARDS) and to evaluate its clinical value. Methods Eighty patients with ARDS were randomly divided into study group( n = 40) and control group( n = 40). Patients in the study group and the control group received individualized treatment and conventional treatment,respectively. And the general situation and prognosis of patients between the two groups were compared. Results After treatment,the heart rate( HR),mean arterial pressure( MAP),oxygenation index( OI) and respiratory index( RI) of patients in the study group were significantly improved( P < 0. 05),and the improvement of HR,OI and RI were significantly better than those in the control group( P < 0. 05). The levels of serum hypersensitivity C reactive protein( hs-CRP),tumor necrosis factor-α( TNF-α) and interleukin-1 β( IL-1 β) in the study group after treatment were significantly lower than those before treatment and those in the control group after treatment( P < 0. 05). Compared with the control group,the study group had shorter mechanical ventilation time and shorter ICU hospitalization time( P < 0. 05). Moreover,the incidence of ventilator associated pneumonia( VAP) and the case fatality rate in the study group were obviously lower than those in the control group,with the differences statistically significant( P < 0. 05). Conclusion The individualized therapy for ARDS could effectively improve pulmonary oxygenation function,reduce inflammation,shorten mechanical ventilation time and improve prognosis,and it has higher clinical application value.
Objective To observe the efficacy of individualized therapy for acute respiratory distress syndrome( ARDS) and to evaluate its clinical value. Methods Eighty patients with ARDS were randomly divided into study group( n = 40) and control group( n = 40). Patients in the study group and the control group received individualized treatment and conventional treatment,respectively. And the general situation and prognosis of patients between the two groups were compared. Results After treatment,the heart rate( HR),mean arterial pressure( MAP),oxygenation index( OI) and respiratory index( RI) of patients in the study group were significantly improved( P < 0. 05),and the improvement of HR,OI and RI were significantly better than those in the control group( P < 0. 05). The levels of serum hypersensitivity C reactive protein( hs-CRP),tumor necrosis factor-α( TNF-α) and interleukin-1 β( IL-1 β) in the study group after treatment were significantly lower than those before treatment and those in the control group after treatment( P < 0. 05). Compared with the control group,the study group had shorter mechanical ventilation time and shorter ICU hospitalization time( P < 0. 05). Moreover,the incidence of ventilator associated pneumonia( VAP) and the case fatality rate in the study group were obviously lower than those in the control group,with the differences statistically significant( P < 0. 05). Conclusion The individualized therapy for ARDS could effectively improve pulmonary oxygenation function,reduce inflammation,shorten mechanical ventilation time and improve prognosis,and it has higher clinical application value.
引文
[1]中华医学会重症医学分会.急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)[J].中华急诊医学杂志,2007,16(4):21-22.
[2]Costa EL,Amato MB.The new definition for acute lung injury and acute respiratory distress syndrome:is there room for improvement[J].Curr Opin Crit Care,2013,19(1):16-23.
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[4]刘双,孙凌波,米玉红,等.不同病因导致急性呼吸窘迫综合征应用体外膜式氧合治疗体会[J].心肺血管病杂志,2011,30(1):8-12.
[5]俞森洋.对急性呼吸窘迫综合征诊断新标准(柏林定义)的解读和探讨[J].中国呼吸与危重监护杂志,2013,12(1):1-4.
[6]李刚莲,简华刚.ARDS诊断标准和通气策略的进展[J].重庆医学,2015,44(32):4592-4594.
[7]赵晓东,刘红升.创伤患者急性呼吸窘迫综合征的诊治策略-掌握规律,实施时效与整体性救治[J].解放军医学杂志,2016,41(8):613-617.
[8]Diaz JV,Brower R,Calfee CS,et al.Therapeutic strategies for severe acute lung injury[J].Crit Care Med,2010,38(8):1644-1650.
[9]俞森洋.严重急性呼吸窘迫综合征的挽救性治疗[J].中国呼吸与危重监护杂志,2011,10(5):417-420.
[10]赵亮.肺源性和肺外源性急性呼吸窘迫综合征治疗与预后的临床观察[J].中国医师进修杂志,2011,34(1):45-47.
[11]支德源,段美丽,张淑文,等.ARDS患者预后影响因素分析[J].山东医药,2015,55(39):82-84.
[12]Gómez-Laberge C,Wolf GK.Toward individualized treatment of acute respiratory distress syndrome:response-guided mechanical ventilation[J].Pediatr Crit Care Med,2011,12(6):690-692.
[13]刘畅,李建国.急性呼吸窘迫综合征:新定义与新进展[J].实用医院临床杂志,2012,9(6):15-19.
[14]李捷.乌司他丁联合CRRT治疗对急性呼吸窘迫综合征患者内皮氧化性损伤和炎症性损伤的影响[J].海南医学院学报,2017,23(8):1044-1047,1051.
[15]曹学雷,黄欢,孙晓红,等.乌司他丁联合血必净注射液治疗老年重症肺炎的临床效果[J].医学综述,2016,22(20):4136-4138.
[16]苏俊,张颖,胡炜,等.布托啡诺联合右美托咪定对重症加强治疗病房患者镇痛镇静的疗效分析[J].中国中西医结合急救杂志,2016,23(2):168-171.
[17]郑红丽.右美托咪定对急性肺损伤患者免疫炎性反应影响及临床作用[J].现代中西医结合杂志,2015,24(18):1954-1957.
[18]李峥,黄华,陈凤坤,等.甘草酸二铵与黄芪注射液对急性肺损伤肺保护作用的研究[J].世界中西医结合杂志,2013,8(10):1025-1027.
[2]Costa EL,Amato MB.The new definition for acute lung injury and acute respiratory distress syndrome:is there room for improvement[J].Curr Opin Crit Care,2013,19(1):16-23.
[3]刘晶晶,姜丽华,王蕾,等.急性呼吸窘迫综合征治疗的研究进展[J].临床麻醉学杂志,2014,30(11):1137-1139.
[4]刘双,孙凌波,米玉红,等.不同病因导致急性呼吸窘迫综合征应用体外膜式氧合治疗体会[J].心肺血管病杂志,2011,30(1):8-12.
[5]俞森洋.对急性呼吸窘迫综合征诊断新标准(柏林定义)的解读和探讨[J].中国呼吸与危重监护杂志,2013,12(1):1-4.
[6]李刚莲,简华刚.ARDS诊断标准和通气策略的进展[J].重庆医学,2015,44(32):4592-4594.
[7]赵晓东,刘红升.创伤患者急性呼吸窘迫综合征的诊治策略-掌握规律,实施时效与整体性救治[J].解放军医学杂志,2016,41(8):613-617.
[8]Diaz JV,Brower R,Calfee CS,et al.Therapeutic strategies for severe acute lung injury[J].Crit Care Med,2010,38(8):1644-1650.
[9]俞森洋.严重急性呼吸窘迫综合征的挽救性治疗[J].中国呼吸与危重监护杂志,2011,10(5):417-420.
[10]赵亮.肺源性和肺外源性急性呼吸窘迫综合征治疗与预后的临床观察[J].中国医师进修杂志,2011,34(1):45-47.
[11]支德源,段美丽,张淑文,等.ARDS患者预后影响因素分析[J].山东医药,2015,55(39):82-84.
[12]Gómez-Laberge C,Wolf GK.Toward individualized treatment of acute respiratory distress syndrome:response-guided mechanical ventilation[J].Pediatr Crit Care Med,2011,12(6):690-692.
[13]刘畅,李建国.急性呼吸窘迫综合征:新定义与新进展[J].实用医院临床杂志,2012,9(6):15-19.
[14]李捷.乌司他丁联合CRRT治疗对急性呼吸窘迫综合征患者内皮氧化性损伤和炎症性损伤的影响[J].海南医学院学报,2017,23(8):1044-1047,1051.
[15]曹学雷,黄欢,孙晓红,等.乌司他丁联合血必净注射液治疗老年重症肺炎的临床效果[J].医学综述,2016,22(20):4136-4138.
[16]苏俊,张颖,胡炜,等.布托啡诺联合右美托咪定对重症加强治疗病房患者镇痛镇静的疗效分析[J].中国中西医结合急救杂志,2016,23(2):168-171.
[17]郑红丽.右美托咪定对急性肺损伤患者免疫炎性反应影响及临床作用[J].现代中西医结合杂志,2015,24(18):1954-1957.
[18]李峥,黄华,陈凤坤,等.甘草酸二铵与黄芪注射液对急性肺损伤肺保护作用的研究[J].世界中西医结合杂志,2013,8(10):1025-1027.