布地奈德雾化联合PCV肺复张方法对ARDS患者血流动力学氧合状态及炎症反应的影响

doi:10.3969/j.issn.1006-6233.2023.05.027

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Abstract Objective: To observe the effect of budesonide nebulization combined with pressure controlled ventilation (PCV) lung recruitment method on hemodynamics, oxygenation status and inflammatory response in patients with acute respiratory distress syndrome (ARDS). Methods: A total of 103 patients with ARDS admitted in our hospital from February 2019 to May 2022 were selected and divided into control group (51 cases) and observation group (52 cases) by simple randomization method. Both groups were intervened with PCV lung recruitment maneuver. The observation group was given budesonide nebulization treatment, and the control group was given 0.9% sodium chloride solution nebulization treatment. The oxygenation status, hemodynamics and inflammatory reaction levels were compared between the two groups, and the duration of mechanical ventilation, length of stay in ICU and mortality were recorded. Results: Before treatment, there were no significant statistical differences in oxygenation-related indexes and hemodynamics between the two groups (P>0.05). After treatment, the arterial oxygen partial pressure (PaO₂), oxygenation index (PaO₂/FiO₂) and central venous pressure (CVP) in both groups were significantly higher than before treatment, while the mean arterial pressure (MAP) and heart rate (HR) were significantly lower than before treatment. The comparison between groups suggested that the oxygenation status index in the observation group was higher than that in the control group after treatment. The difference was statistically significant (P<0.05), while there was no significant statistical difference in hemodynamics between the observation group and the control group after treatment (P>0.05). The differences of oxygenation status index, MAP and CVP in the observation group before and after treatment were greater than that in the control group, and the difference was statistically significant (P<0.05), while the difference of HR before and after treatment was not statistically significant (P>0.05). Before treatment, there was no significant statistical difference in inflammatory reaction between the two groups (P>0.05). After treatment, the neutrophil to lymphocyte ratio (NLR), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and procalcitonin (PCT) in both groups were significantly decreased compared with that before treatment, and the comparison between the two groups suggested that the inflammatory indexes in the observation group was significantly lower than those in the control group after treatment, while the difference before and after treatment was larger than that in the control group (P<0.05). The mechanical ventilation time and ICU stay time in the observation group were shorter than those in the control group, and there was no significant statistical difference in mortality between the observation group and the control group (P>0.05). Conclusion:Budesonide nebulization combined with PCV lung recruitment maneuver in the treatment of ARDS can improve the hemodynamics and oxygenation status of patients, reduce the inflammatory response, and promote the recovery of patients.

Key words： Budesonide Pressure controlled ventilation Lung recruitment Acute respiratory distress syndrome Oxygenation status

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2023.05.027 OR http://www.hbyxzzs.cn/EN/Y2023/V29/I5/834