有创与无创序贯性机械通气治疗老年重症肺炎并急性呼吸衰竭

Sequential Non-invasive following Short-term Invasive Mechanical Venti lation in Elderly Patients of Severe Pneumonia with Acute Respiratory Failure

目的 :探讨有创与无创序贯性机械通气在老年重症肺炎并急性呼吸衰竭的疗效及可行性。方法 :选择接受气管插管机械通气的老年重症肺炎 12例设为序贯治疗组 ,以同步间隙指令通气 +压力支持 +呼气末正压 (SIMV +PSV +PEEP)方式行机械通气 ,待“肺部感染控制窗”出现时可拔除气管插管 ,改换经面罩双水平正压通气 (PSV +PEEP) ,以后渐减PSV水平直至脱离呼吸机。选择同样病例 12例作为对照组 ,行常规有创通气以SIMV +PSV方式撤机。动态观察两组病例的感染、通气及氧合指标 ,记录有创和总机械通气时间、呼吸机相关肺炎 (VAP)发生情况及住呼吸重症监护病房 (RICU)的天数。结果 :序贯治疗组与对照组治疗前的血气分析结果相仿 (P <0 .0 5 ) ;有创通气时间分别为 (4.3± 2 .1)d和 (11.4± 4 .3)d(P <0 .0 1) ;总的机械通气时间分别为 (7.2± 2 .2 )d和 (11.4± 4 .3)d(P <0 .0 5 ) ;VAP发生例数分别为 1例和 7例 (P <0 .0 1)。结论 :对老年重症肺炎并急性呼吸衰竭行有创与无创序贯性机械通气治疗可显著改善治疗效果。

Objective:To discuss the feasibility an d th e efficacy of sequential noninvasive following short-term invasive mechanical ve ntilation (MV) in elderly patients of severe pneumonia with acute respiratory fa ilure. Methods:24 intubated elderly patients of pneumonia ca ses with acute respiratory failure were studied.Among them,12 cases(study group) were treated by sequential noninvasive following short-term invasive MV when pu lmonary infection had been controlled,the others were treated by invasive MV con tinuously(control group).The sequential ventilation group received the following ventilation modality:SIMV+PSV+PEEP,and when pulmonary infection were controlled ,then the ventilation modality was switched to oranasal face PSV+PEEP,followed b y PSV untile the weaning.The control group received invasive ventilation modalit y,and weaned with SIMV+PSV.The parameters including infection,ventilation and ox ygenation,ventilation duration,ventilatator-associated pneumonia (VAP),duration of ICU stay were serially measured.Results: Both groups had s i milar clinical characteristics and gas exchange (P>0.05),Between the sequent ial group and control group,the durations of MV were(4.3±2.1)days vs (11.4±4.3 )days,(P<0.01),the totlal duration of ventilatory support was (7.2±2.2) vs (11.4±4.3) days (P<0.05),the incidents of VAP were 1/12 vs 7/12, (P<0.0 1),respectively.Conclusion: In elderly patients of pneumonia r equiring intubation and MV,early extubation followed by non-invasive MV may sign ificantly increase the efficacy of the comprehensive therapy.