ABSTRACT
Objective To investigate the effect of mechanical ventilation in prone position combined with lung recruitment on severe acute respiratory distress syndrome (ARDS).Methods From February 2015 to February 2017,82 patients with ARDS admitted to ICU of the Second Hospital of Shanxi Medical University were divided into two groups according to random number table,with 41 cases in each group.The study group was treated with mechanical ventilation in prone position combined with lung recruitment therapy,and the control group was treated with mechanical ventilation in supine position combined with lung recruitment therapy.The differences of heart rate (HR),central venous pressure (CVP),mean arterial pressure (MAP),partial pressure of oxygen (PaO2),oxygenation index (PaO2/FiO2),plateau pressure (Pplat),and static pulmonary compliance (Cst) were compared between the two groups before treatment (T0),and 1h (T1),2h (T2),6h (T3) after treatment.Results The PaO2 and PaO2/FiO2 levels of the two groups increased significantly after lung recruitment.In the study group at different time after treatment,PaO2 [(69.17 ±7.51) mmHg,(74.64 ±6.78) mmHg,(82.52 ± 10.37) mmHg],PaO2/FiO2 [(116.91 ±15.57) mmHg,(123.06 ± 16.34) mmHg,(135.23 ± 18.41) mmHg] were higher than those in the control group [PaO2:(64.23 ± 7.72) mmHg,(68.51 ± 8.05) mmHg,(73.43 ± 9.12) mmHg;PaO2/FiO2:(106.50 ± 12.97) mmHg,(115.42 ± 13.19) mmHg,(123.42 ± 14.95) mmHg],the differences were statistically significant (t =3.225,3.254,4.245,3.954,3.886,4.135,all P ＜ 0.05).HR and CVP increased at T2-T3,T3 decreased,MAP decreased at T2-T3,and T3 increased in both two groups.HR at T1-T3 in the study group were (123.17 ± 13.41) times/min,(114.64 ± 10.08) times/min,(102.52 ± 6.57) times/min,which were lower than those in the control group [(129.23 ±12.75) times/min,(117.51 ± 10.35) times/min,(108.43 ± 9.77) times/min],the differences between the two groups were statistically significant (t =3.884,4.215,4.667,all P ＜ 0.05).Conclusion Prone position mechanical ventilation combined with lung recruitment can effectively improve the oxygenation status of severe ARDS,and has less effect on hemodynamics,and the effect is better than supine position mechanical ventilation combined with lung recruitment.
ABSTRACT
Objective@#To investigate the effect of mechanical ventilation in prone position combined with lung recruitment on severe acute respiratory distress syndrome (ARDS).@*Methods@#From February 2015 to February 2017, 82 patients with ARDS admitted to ICU of the Second Hospital of Shanxi Medical University were divided into two groups according to random number table, with 41 cases in each group.The study group was treated with mechanical ventilation in prone position combined with lung recruitment therapy, and the control group was treated with mechanical ventilation in supine position combined with lung recruitment therapy.The differences of heart rate (HR), central venous pressure (CVP), mean arterial pressure (MAP), partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), plateau pressure (Pplat), and static pulmonary compliance (Cst) were compared between the two groups before treatment (T0), and 1h (T1), 2h (T2), 6h (T3) after treatment.@*Results@#The PaO2 and PaO2/FiO2 levels of the two groups increased significantly after lung recruitment.In the study group at different time after treatment, PaO2[(69.17±7.51)mmHg, (74.64±6.78)mmHg, (82.52±10.37)mmHg], PaO2/FiO2 [(116.91±15.57)mmHg, (123.06±16.34)mmHg, (135.23±18.41)mmHg]were higher than those in the control group[PaO2: (64.23±7.72)mmHg, (68.51±8.05)mmHg, (73.43±9.12)mmHg; PaO2/FiO2: (106.50±12.97)mmHg, (115.42±13.19)mmHg, (123.42±14.95)mmHg], the differences were statistically significant (t=3.225, 3.254, 4.245, 3.954, 3.886, 4.135, all P<0.05). HR and CVP increased at T2-T3, T3 decreased, MAP decreased at T2-T3, and T3 increased in both two groups.HR at T1-T3 in the study group were (123.17±13.41)times/min, (114.64±10.08)times/min, (102.52±6.57)times/min, which were lower than those in the control group[(129.23±12.75)times/min, (117.51±10.35)times/min, (108.43±9.77)times/min], the differences between the two groups were statistically significant (t=3.884, 4.215, 4.667, all P<0.05).@*Conclusion@#Prone position mechanical ventilation combined with lung recruitment can effectively improve the oxygenation status of severe ARDS, and has less effect on hemodynamics, and the effect is better than supine position mechanical ventilation combined with lung recruitment.
ABSTRACT
Objective To investigate the curative effect of imipenem cilastatin sodium in the treatment of patients with severe infection complicated with multiple organ dysfunction ,and its effect on blood lactic acid.Methods From January 2012 to January 2017,a total of 124 patients with severe organ failure and multiple organ dysfunction in the Second Hospital of Shanxi Medical University were selected ,and they were randomly divided into study group and control group according to the digital meter method ,with 62 cases in each group.The study group received a broad -spectrum antibiotic imipenem cilastatin sodium treatment , the control group received levofloxacin treatment.The curative effect,bacterial clearance rate,infection control time and the change of BLA level in the two groups were recorded and compared.Results The total effective rate was 82.26%in the study group and 79.03%in the control group,there was no statistically significant difference between the two groups (χ2＝1.187,P＞0.05).The bacterial clearance rate in the study group was 80.00%,which was significantly higher than 52.94%in the control group(χ2＝5.176,P＜0.05).The infection control time in the study group was earlier than that in the control group [(3.17 ± 1.14)d vs.(5.21 ±1.18) d),t ＝11.579,P ＜0.05].Before treatment,there was no statistically significant difference in BLA level between the two groups (t＝1.879,P＞0.05).After treatment,the BLA level in the study group was significantly higher than that in the control group (t＝12.179,P＜0.05),the level of BLA in the study group gradually decreased after one week of withdrawal ,which had no statistically significant difference compared with the control group(t＝1.483,P＞0.05).There was no statistically significant difference in BLA level between the two groups after one week of discontinuation (t＝1.237,P＞0.05).Conclusion Imipenem and cilastatin sodium has good curative effect and bacterial clearance rate in the treatment of patients with severe infection complicated with multiple organ dysfunction.It can control the infection more promptly and has a significant effect on the prognosis of patients.It is worthy of widely clinical promotion and application.