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目的观察早期应用肌松剂对重度肺内源性急性呼吸窘迫综合征(ARDS)患者机械通气疗效的影响。方法采用回顾性分析方法,选择2015年1月至7月在河南中医学院第一附属医院重症医学科住院的55例行机械通气的重度肺内源性ARDS患者为研究对象,其中插管后联合应用肌松剂(应用时间<48 h)和镇痛、镇静药物的25例为肌松剂组,插管后仅应用镇痛、镇静药物的患者30例为对照组。观察机械通气24 h后两组患者的氧合指数(Pa O2/Fi O2)、肺静态顺应性(Cstat)、平台压(Pplat)及拔管时间、ICU住院时间。结果机械通气24 h后,肌松剂组患者的Pa O2/Fi O2[(152.0±57.0)vs(135.0±43.0),P<0.05)]及Cstat[(32.1±12.2)ml/cm H2O vs(23.1±6.1)ml/cm H2O,P<0.01]高于对照组,Pplat低于对照组[(19.6±6.4)cm H2O vs(26.2±4.0)cm H2O,P<0.01];两组的拔管时间[(6.9±2.9)d vs(7.0±1.3)d]及ICU住院时间[(11.0±7.4)d vs(12.1±1.5)d]比较差异无统计学意义(P均>0.05)。结论早期应用肌松剂可改善机械通气的重度肺内源性ARDS患者的呼吸力学指标及氧合情况,但不影响拔管时间及ICU住院时间。
Objective To observe the effect of early application of muscle relaxant on mechanical ventilation in patients with severe acute respiratory distress syndrome (ARDS). Methods A retrospective analysis was conducted in 55 patients with severe pulmonary endogenous ARDS who were hospitalized in the Department of Critical Care Medicine, the First Affiliated Hospital of Henan College of Traditional Chinese Medicine from January 2015 to July 2015. The patients were enrolled after intubation Application of muscle relaxants (application time <48 h) and analgesia, sedatives in 25 patients with muscle relaxant group, only analgesic after intubation, sedation in patients with drug control group. The PaO2 / Fi O2, Cstat, Pplat, extubation and ICU hospital stay of the two groups were observed 24 h after mechanical ventilation. Results PaO2 / Fi O2 (152.0 ± 57.0 vs 135.0 ± 43.0, P <0.05) and Cstat [(32.1 ± 12.2) ml / cm H2O vs 23.1 ± 6.1) ml / cm H2O, P <0.01], Pplat was lower than that of the control group [(19.6 ± 6.4) cm H2O vs (26.2 ± 4.0) cm H2O, P <0.01] There was no significant difference in time [(6.9 ± 2.9) d vs (7.0 ± 1.3) d] and hospital stay in ICU [(11.0 ± 7.4) d vs (12.1 ± 1.5) d] (all P> 0.05). Conclusion Early application of muscle relaxants can improve the mechanical ventilation of patients with severe pulmonary endogenous ARDS respiratory mechanics and oxygenation, but does not affect the time of extubation and ICU hospital stay.