The Clinical Study Of Low Tidal Volume Ventilation And Sequential Lung Recruitment Manoeuver In The Treatment Of Severe Acute Pancreatitis Complicated With ARDS

Objective:To investigate the clinical effect of the low tidal volume ventilation sequential recruitment manoeuver(RM)in the treatment of the patients of severe acute pancreatitis(SAP)complicated with acute respiratory distress(ARDS).Method:60 cases of SAP complicated with ARDS patients were selected from our hospital ICU,and they were randomly divided in low tidal volume+ optimal PEEP group(control group)and low tidal volume+optimal PEEP combined with recruitment manoeuver group(experimental group).There were 30 cases of each group.On the basis of the comprehensive treatment,the control group were treated with low tidal volume controlled ventilation mode : low tidal volume ventilation(6ml/Kg)+ optimal PEEP ventilation mode.When the abdominal pressure was essentially normal,the experimental group was treated with combined with recruitment manoeuver therapy,and the rest were the same as the control group.To compare the clinical effects of two ventilation strategies and observe the changes of respiratory mechanics indexes,hemodynamics and arterial blood gas indexes in different time.Result:1)The ICU length of stay,the mechanical ventilation time,incidence of VAP of the experimental group were lower than that of the control group,there was crucial difference between the two groups(P < 0.05),But the mortality rate of the experimental group was slightly lower than that of the control group,there was no crucial difference between the two groups(P>0.05)2)The lung static compliance(Cst)of the experimental group was increased,but the peak airway pressure(PIP)and Plateau pressure(Pplat)were decreased,the difference between the two groups in PIP,Pplat and Cst was stastistically significant at the same time point of 12,24,48,72h(P<0.05).3)The Pa02 and PaO2/FiO2 of the experimental group were improved,the difference between the two groups in Pa02,PaO2/FiO2 was stastistically significant at the same time point of 12,24,48,72h(P<0.05).4)There was a transient hemodynamic change in RM,there was significant difference between RM and before the RM(P<0.05),but there was no significant difference at 5min after the RM(P>0.05).Conclusion:When the abdominal pressure was returned to normal,and the strategies timely used the recruitment manoeuver therapeutic for the treatment of SAP complicated with ARDS was more conducive to improve compliance,oxygenation,promote the collapse of the alveol,shorten the course of SAP complicated with ARDS and reduce early mortality of VAP compared with low tidal volume mechanical ventilation on the basis of the low tidal volume+optimal PEEP?...