广西医学

目的探讨精细化腹内压管理对重症急性胰腺炎（SAP）合并急性呼吸窘迫综合征患者（ARDS）呼吸功能的影响。方法选取80例SAP合并ARDS患者并随机分为对照组与观察组，每组40例。对照组实施ICU常规护理，观察组在常规护理的基础上实施精细化腹内压管理。比较两组干预前后的呼吸机参数［呼气末正压（PEEP）、气道峰压（Ppeak）、吸入气氧浓度（FiO2）］、动脉血气分析指标(氧合指数、PaO2、PaCO2)、腹内压，以及机械通气时间及ICU住院时间。结果（1）两组患者的Ppeak、FiO2有随时间变化而降低的趋势，且在干预后3 d、5 d、7 d，观察组Ppeak、FiO2低于对照组（P＜0.05）。（2）两组患者的氧合指数、PaO2有随时间变化而升高的趋势，且干预后3 d、5 d、7 d，观察组患者的氧合指数、PaO2高于对照组（P＜0.05）。两组患者的PaCO2有随时间变化总体呈下降的趋势，且在干预后7 d，观察组患者的PaCO2低于对照组（P＜0.05）。（3）干预后7 d，两组患者的腹内压较干预前降低，且观察组患者的腹内压低于对照组（P＜0.05）。（4）观察组患者的机械通气时间、ICU住院时间短于对照组（P＜0.05）。结论对SAP合并ARDS患者实施精细化腹内压管理可以降低腹内压，从而改善患者的呼吸功能。

ObjectiveTo investigate the effect of refined internal abdominal pressure management on respiratory function in patients with severe acute pancreatitis (SAP) and concomitant acute respiratory distress syndrome (ARDS). MethodsA total of 80 SAP and concomitant ARDS patients were selected, and they were randomly divided into control group or observation group, with 40 cases in each group. The control group received ICU routine nursing, based on which the observation group received refined internal abdominal pressure management. The ventilator parameters with respect to positive end-expiratory pressure (PEEP), peak airway pressure (Ppeak), fractional concentration of inspired oxygen (FiO2), arterial blood gas analysis indices in terms of oxygenation index, PaO2, PaCO2, and internal abdominal pressure, as well as mechanical ventilation duration and length of ICU stay were compared between the two groups before and after intervention. Results(1) The Ppeak and FiO2 of the two groups interpreted a decreasing trend with time, and after 3, 5 and 7 days of intervention, Ppeak and FiO2 of the observation group were lower than those of the control group (P＜0.05). (2) The oxygenation index and PaO2 of the two groups exhibited an elevating trend with time, and the oxygenation index and PaO2 of the observation group were higher than those of the control group 3, 5 and 7 days after intervention (P＜0.05). The PaCO2 of the two groups indicated a downward trend over time, and the PaCO2 of the observation group was lower than that of the control group 7 days after intervention (P＜0.05). (3) Seven days after intervention, the internal abdominal pressure of the two groups were lower than those before intervention, and the internal abdominal pressure of the observation group was lower than that of the control group (P＜0.05). (4) The observation group yielded shorter mechanical ventilation duration and length of ICU stay as compared with the control group (P＜0.05). ConclusionApplying refine internal abdominal pressure management to patients with SAP and concomitant ARDS can decrease internal abdominal pressure, so as to ameliorate patients′ respiratory function.