目的 分析苯磺顺阿曲库铵辅助中重度急性呼吸窘迫综合征(ARDS)患者俯卧位机械通气的应用效果及对预后的影响.方法 将中重度ARDS患者依据治疗方法不同使用队列法分为对照组和试验组.对照组给予俯卧位机械通气治疗;试验组给予0.15 mg·kg-1苯磺顺阿曲库铵辅助俯卧位机械通气治疗.比较2组患者机械通气时长、脱机时长、总住院时间、机械通气前后氧合指数(OI)、呼吸机相关参数[平均动脉血氧分压(PaO2)、氧合指数(OI)、中心静脉压(CVP)]、急性生理学和慢性健康状况评估Ⅱ(APACHE Ⅱ)评分及序贯器官衰竭评估量表(SOFA)评分、炎症因子[白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]水平、近期死亡率、并发症发生率.结果 试验组和对照组分别纳入39和41例.治疗后,试验组和对照组的脱机时长分别为(15.11±1.97)和(12.01±1.62)d,在统计学上差异有统计学意义(P＜0.05).机械通气后3 d,试验组和对照组的PaO2分别为(88.24±9.05)和(80.01±8.34)mmHg,OI 分别为(219.87±22.01)和(170.86±18.53)％,IL-6分别为(18.04±1.92)和(26.23±3.04)ng·mL-1;治疗后,试验组和对照组的APACHE Ⅱ 评分分别为(16.05±1.74)和(20.05±1.08)分,SOFA 评分分别为(5.04±0.66)和(7.23±1.05)分;试验组和对照组出院后90 d内死亡率分别为2.56％和19.51％,并发症总发生率分别为7.69％和29.27％.试验组上述指标与对照组比较,在统计学上差异均有统计学意义(均P＜0.05).试验组出院后90天内死亡率(2.56％)明显低于对照组(19.51％,P＜0.05),并发症总发生率(7.69％)明显低于对照组(29.27％,P＜0.05).结论 苯磺顺阿曲库铵辅助俯卧位机械通气在中重度ARDS患者中有明确应用效果,有效改善患者的预后.
Objective To analyze the application effect of cisatracurium besilate assisted mechanical ventilation in patients with moderate to severe acute respiratory distress syndrome(ARDS)and the impact on prognosis.Methods Patients with moderate to severe ARDS were divided into the control group and the treatment group according to different treatment methods using cohort method.The control group was treated with mechanical ventilation in prone position.The treatment group was treated with cisatracurium besilate(0.15 mg·kg-1)assisted mechanical ventilation in prone position.The duration of mechanical ventilation,weaning time,total length of hospital stay,ventilator-related parameters[arterial partial pressure of oxygen(PaO2),oxygenation index(OI)and central venous pressure(CVP)],the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)scores,Sequential Organ Failure Assessment Scale(SOFA)scores,inflammatory factors[interleukin-6(IL-6),interleukin-8(IL-8)and tumor necrosis factor-α(TNF-α)],short-term mortality and the incidence of complications were compared between the groups.Results The treatment group and the control group included 39 and 41 cases,respectively.The offline duration for the treatment group and the control group were(15.11±1.97)and(12.01±1.62)days,with statistically significant differences(P＜0.05).Three days after mechanical ventilation,the PaO2 for the treatment group and the control group were(88.24±9.05)and(80.01±8.34)mmHg;OI were(219.87±22.01)and(170.86±18.53)mmHg·％-1;IL-6 was(18.04±1.92)and(26.23±3.04)ng·mL-1,respectively.After treatment,the APACHE Ⅱ scores for the treatment group and the control group were(16.05±1.74)and(20.05±1.08)points;the SOFA scores were(5.04±0.66)and(7.23±1.05)points.The mortality rates within 90 days after discharge for the treatment group and the control group were 2.56％and 19.51％,and the overall complication rates were 7.69％and 29.27％.Statistically significant differences were observed in the comparison of the above indicators between the treatment group and the control group(all P＜0.05).The death rate of the treatment group within 90 days after discharge(2.56％)was significantly lower than that of the control group(19.51％,P＜0.05),and the total complication rate(7.69％)was significantly lower than that of the control group(29.27％,P＜0.05).Conclusion Cisatracurium besilate assisted mechanical ventilation in prone position has a definite application effect in patients with moderate to severe ARDS,and can effectively improve the prognosis.
胡军军;黄建东;卢周晓;胡壮文
浙江中医药大学研究生院,浙江杭州 310053||浙江金华广福肿瘤医院麻醉科,浙江金华 321000浙江金华广福肿瘤医院重症医学科,浙江金华 321000浙江金华广福肿瘤医院呼吸与危重症医学科,浙江金华 321000浙江金华广福肿瘤医院麻醉科,浙江金华 321000
药学
苯磺顺阿曲库铵;呼吸窘迫综合征;中重度;俯卧位机械通气;预后
cisatracurium besilate;respiratory distress syndrome;moderate to severe;mechanical ventilation in prone position;prognosis
《中国临床药理学杂志》 2024 (006)
792-796 / 5
金华市公益性技术应用研究基金资助项目(2023-4-184)
10.13699/j.cnki.1001-6821.2024.06.002
评论