Clinical Study On Postoperative Ards Treated By Pulmonary Retraction Combined With Protective Ventilation

Objective: To investigate the clinical effect of pulmonary retraction combined with protective mechanical ventilation in postoperative patients with acute respiratory distress syndrome?ARDS?.Methods: Using prospective randomized controlled clinical study method,patients with moderate to severe ARDS after surgery from June 2017 to June 2019 were selected as study subjects,and randomly divided into the standard treatment group?Group A?and the lung retention + protection mechanical ventilation treatment group?group B?.After transferred to ICU,ARDS patients were given the standard treatment of primary disease,protective mechanical ventilation strategy,airway warming and humidification,etc.Lung protective mechanical ventilation strategies,including pressure controlled ventilation?PCV?mode,tidal volume?VT?>5 m L/kg,inspiratory time 0.8 1.2s,and driving pressure <15cm H2 O.The treatment group was combined with intermittent pulmonary retraction on the basis of the standard treatment group.The maximum length of PEEP was up to 20-25 cm H2 O and was maintained for 20-30 seconds each time.Pulmonary retraction was performed once every 6h,3 times daily in the morning,in the middle and in the evening.The changes of respiratory function,hemodynamic index and complications before and after daily treatment were compared between the two groups.Results:1.General data comparison: two groups of patients during the study period were included in the 69 cases complicated with moderately severe ARDS patients after the surgery,which occurred in 1 case complicated with pneumothorax,1 case was ruled out for with severe pulmonary hypertension,and ultimately,a total of 67 patients were included in the analysis,the standard treatment group 35 cases,lung after treatment group 32 cases,the source of the gender,age,two groups of patients,acute physiology and chronic health evaluation system ??APACHE ??score data such as the comparison of difference was not statistically significant?P > 0.05?.2.Comparison of respiratory function indicators between the two groups: there was no significant difference in basic oxygenation index?PaO₂/FiO₂?,autonomous Vt,pulmonary compliance?Cst?,etc.Compared with the standard treatment group,PaO₂/FiO₂ in the pulmonary retention treatment group was significantly increased?P<0.05?,and pulmonary compliance showed an improvement trend?P>0.05?.The tidal volume of spontaneous respiration also increased between the two groups,but there was no significant difference.After three standard treatments,PaO₂/FiO₂ in the pulmonary retention group was significantly increased?P<0.001?,and lung compliance and tidal volume were improved?P<0.05?.3.Mean arterial pressure?MAP?and heart rate?HR?of the two groups were used as hemodynamic indexes before and after treatment,and the differences were not statistically significant?all P>0.05?.4.Comparison of prognosis between the two groups.Compared with the standard group,the length of ICU stay,mechanical ventilation time and artificial airway removal time in the pulmonary retention treatment group were significantly shortened?all P < 0.01?.5.Comparison of complications between the two groups.No pneumothorax or mediastinal emphysema occurred in the two groups,and there were no deaths during the 28 d follow-up.Conclusion: Compared with standard treatment,combined lung expansion and protective ventilation can improve lung compliance,correct hypoxemia,shorten mechanical ventilation duration and ICU stay,improve curative effect and promote patient recovery.