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目的:分析无创正压通气治疗创伤性湿肺的临床疗效。方法:对2010年3月至2014年12月河北省廊坊市人民医院普胸外科收治的创伤性湿肺患者124例,随机分为研究组与对照组。研究组患者给予无创呼吸机辅助通气24h,对照组患者给予正常流量氧气吸入。观察2组患者治疗前后肺部CT渗出性病灶变化。比较2组患者氧动力学指标二氧化碳分压(PaCO_2)、氧分压(PaO_2)、氧合指数(PaO_2/FiO_2),心电监护指标参数:呼吸频率(RR)、心率(HR)、氧饱和度(SPO_2)水平变化。结果:治疗前,2组患者临床基础资料比较差异无统计学意义(P>0.05)。创伤性湿肺CT表现为肺纹理增重,模糊,粗细不均,肺内弥漫渗出性密度增高影,呈面纱征或者毛玻璃影,以及片状、云絮状密度增高影,部分患者可见肺内血肿呈圆形或者椭圆形密度增高影,胸腔内可见积液以及积气影。研究组患者24小时后,肺内渗出病变影像范围较前未见明显增大,而对照组患者存在不同程度进展,表现为病变范围较前增大,2组差异有统计学意义(P<0.05)。治疗后24h,研究组患者氧动力学指标PaO_2、PaO_2/FiO_2明显升高,PaCO_2下降。RR、HR水平下降,SPO_2上升,2组比较差异有统计学意义(P<0.05)。结论:早期应用无创正压通气治疗可以减轻创伤性湿肺患者肺损伤病情进展,有助于患者血氧气体交换改善,稳定生命体征。
Objective: To analyze the clinical efficacy of non-invasive positive pressure ventilation in the treatment of traumatic wet lung. Methods: From March 2010 to December 2014, 124 patients with traumatic wet lung admitted to General Thoracic Surgery, Langfang People’s Hospital of Hebei Province were randomly divided into study group and control group. Patients in the study group were given noninvasive ventilator-assisted ventilation for 24 hours and patients in the control group were given normal-flow oxygen inhalation. The changes of pulmonary CT exudate in two groups before and after treatment were observed. PaCO 2, PaO 2 and PaO 2 / FiO 2 were compared between the two groups. Parameters of ECG monitoring were respiratory rate (RR), heart rate (HR), oxygen saturation Degree (SPO_2) level changes. Results: Before treatment, there was no significant difference in clinical basic data between the two groups (P> 0.05). Traumatic wet lung CT showed lung weight gain, blurred, uneven thickness, increased diffuse lung effusion density, showing veil or frosted glass, and flaky, cloud-like density increased shadow, some patients showed lung The hematoma was round or oval density increased shadow, see the pleural effusion and gas shadow. After 24 hours in study group, there was no significant increase in the range of pulmonary edema lesions compared with those in the control group, while the control group patients showed varying degrees of progression. The range of lesions was increased compared with the former group, and the difference between the two groups was statistically significant (P < 0.05). At 24 h after treatment, the oxygenation parameters PaO 2, PaO 2 / FiO 2 and PaCO 2 in the study group were significantly increased. RR, HR decreased, SPO_2 increased, the difference between the two groups was statistically significant (P <0.05). Conclusion: The early application of noninvasive positive pressure ventilation can reduce the progression of lung injury in patients with traumatic wet lung, and help to improve the blood oxygen exchange and stabilize vital signs.