CAJ | 학술논문

目的研究采用俯卧位和仰卧位保护性通气模式对误吸性急性肺损伤患者的影响,并探讨其机制.方法 2009年1月至2012年12月的误吸性急性肺损伤患者60例,随机分为A组和B组,每组30例.两组均采用急诊经纤维支气管镜治疗和保护性通气模式(小潮气量+呼气末正压通气)辅助通气.A组采取俯卧位,B组仰卧位.检测两组患者治疗前和治疗后24 h的呼吸功能、血流动力学指标及血清白介素6(IL 6)、肿瘤坏死因子α(TNF-α)的水平,并随访4周时两组的临床预后.结果 A组患者治疗后24 h时的动脉血氧分压、氧合指数、脉搏血氧饱和度和心率改善优于B组(P＜0.01),A组患者血清IL-6和TNF-α的水平显著低于B组(P＜0.01).治疗后4周A组的病死率(3.33％)低于B组(20.00％)(P＜0.05).结论俯卧位保护性通气可改善误吸性急性肺损伤患者的临床预后,其机制可能与改善患者呼吸功能和抑制炎症介质有关.
목적 연구채용부와위화앙와위보호성통기모식대오흡성급성폐손상환자적영향,병탐토기궤제.방법 2009년1월지2012년12월적오흡성급성폐손상환자60례,수궤분위A조화B조,매조30례.량조균채용급진경섬유지기관경치료화보호성통기모식(소조기량+호기말정압통기)보조통기.A조채취부와위,B조앙와위.검측량조환자치료전화치료후24 h적호흡공능、혈류동역학지표급혈청백개소6(IL 6)、종류배사인자α(TNF-α)적수평,병수방4주시량조적림상예후.결과 A조환자치료후24 h시적동맥혈양분압、양합지수、맥박혈양포화도화심솔개선우우B조(P＜0.01),A조환자혈청IL-6화TNF-α적수평현저저우B조(P＜0.01).치료후4주A조적병사솔(3.33％)저우B조(20.00％)(P＜0.05).결론 부와위보호성통기가개선오흡성급성폐손상환자적림상예후,기궤제가능여개선환자호흡공능화억제염증개질유관.
Objective To investigate the effect of different position on the clinical prognosis of acute lung injury of inhalation and to explore the mechanism.Methods 60 patients with acute lung injury of inhalation,which visited our hospital from January 2009 to December 2012,were randomly divided into group A and group B,30 cases in each group.All cases in both groups received basic treatment of fibro-bronchoscope and low tidal volume ± positive end expiratory pressure lung protective ventilation.Cases in group A received ventilation in prone position,and cases in group B received ventilation in supine position.Respiratory function,level of interleukin-6 and tumor necrosis factor-α in both groups were detected before and 24 h after treatment,and clinical prognosis in four weeks after treatment was followed.Results Arterial partial pressure of oxygen,oxygenation index,saturation of pulse oximetry,and heart rate in group A were better than those in group B (P ＜0.01),and levels of interleukin-6 and tumor necrosis factor-α in group A were lower than those in group B (P ＜0.01).The mortality in group A (3.33％) was lower than that in group B (20.00％,P ＜0.05).Conclusions Prone position can improve clinical prognosis of acute lung injury of inhalation,and the mechanism is probably related to improving the respiratory function and inhibiting the inflammatory status.