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目的:探讨呼吸机小潮气量容量控制反比通气(LTVC-IRV)改善急诊重度吸入性肺炎并发急性呼吸窘迫综合征(ARDS)患者早期氧合功能的临床效果及其可能的作用机制。方法:回顾性分析20例重度吸入性肺炎并发ARDS患者的临床资料及治疗护理措施,统计对比分析LTVC-IRV治疗前后股动脉血气指标?平均气道压(mAP)及右上肢袖带平均动脉压(MAP)的变化。结果:LTVC-IRV治疗1 h及4 h后与治疗前(CMV治疗1 h)相比:①PaO2/F iO2比值在1 h后与治疗前比较差异无统计学意义(P>0.05),但4 h后较治疗前显著增加(P<0.01);②1 h及4 h后较治疗前的PAP显著降低,mAP逐渐显著增加,比较差异均有统计学意义(P<0.01);③1 h及4 h后的MAP与治疗前比较差异无统计学意义(P>0.05)。结论:LTVC-IRV治疗重度吸入性肺炎合并ARDS时,早期降低PAP及增加mAP,数小时后可明显改善患者肺氧合功能而对血流动力学无明显影响。
Objective: To investigate the clinical effect and possible mechanism of ventilator small tidal volume-controlled inverse-phase ventilation (LTVC-IRV) on early oxygenation in patients with acute severe respiratory aspiration pneumonia complicated with acute respiratory distress syndrome (ARDS). Methods: A retrospective analysis of 20 cases of severe aspiration pneumonia complicated with ARDS patients with clinical data and treatment and care measures were statistically analyzed before and after treatment of LTVC-IRV femoral artery blood gas index mean airway pressure (mAP) and right upper arm cuff mean arterial pressure (MAP) changes. Results: Compared with before treatment (1 h after CMV treatment), the ratio of PaO2 / F iO2 at 1 h and 4 h after treatment with LTVC-IRV showed no significant difference (P> 0.05) after 1 h compared with before treatment (P <0.01); ② After 1 h and 4 h, PAP was significantly lower than before treatment, mAP gradually increased, the differences were statistically significant (P <0.01); ③ At 1 h and 4 h There was no significant difference between MAP and before treatment (P> 0.05). Conclusions: LTVC-IRV treatment of severe aspiration pneumonia combined with ARDS can reduce PAP and increase mAP early, and can significantly improve pulmonary oxygen function in a few hours without significant effect on hemodynamics.