无创-有创机械通气序贯治疗切换时机的临床研究

Clinical study on the switching timing of sequential treatment of non-invasive and invasive mechanical ventilation

目的探讨无创-有创机械通气序贯治疗的切换时机。方法选择2019年1月~2020年5月中山医院收治的80例慢性阻塞性肺疾病急性加重(AECOPD)患者作为研究对象,采用随机数字表法分为两组,每组各40例。对照组采用经验治疗,观察组采用以肺部感染控制窗的有无为有创呼吸与无创呼吸切换点的治疗。比较两组治疗前后炎症因子水平和肺功能的变化,比较两组治疗过程中圣乔治问卷(SGRQ)评分的变化,以及并发症(呼吸机相关肺炎、气胸和心力衰竭)的发生情况。结果治疗后观察组肿瘤坏死因子-α(TNF-α)和超敏-C反应蛋白(hs-CRP)水平低于对照组,差异有统计学意义(P<0.05);观察组第一秒用力呼气容积(FEV1)和用力肺活量比值(FEV1/FVC)高于对照组,差异有统计学意义(P<0.05);治疗后48 h及治疗后7 d,两组SGRQ评分低于治疗前,且观察组SGRQ评分低于对照组,差异有统计学意义(P<0.05);观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论针对无创-有创呼吸机序贯治疗者,应用肺部感染控制窗作为切换点,能有效地降低机体炎症反应,改善呼吸功能,减少并发症发生率。

Objective To explore the switching time of sequential with non-invasive and invasive mechanical ventilation.Methods A total of 80 cases with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)admitted to Zhongshan Hospital from January 2019 to May 2020 were selected as research objects and divided into two groups according to random number table method,with 40 cases in each group.The control group was treated with experience,while the observation group was treated with the switch point between invasive breathing and non-invasive breathing in the control window of lung infection.The levels of inflammation-related factors,pulmonary function,St.George′s respiratory questionnaire(SGRQ)scores before and after treatment and complications of the two groups were compared,the main complications included ventilator-associated pneumonia,pneumothorax and heart failure.Results The levels of tumor necrosis factor-α(TNF-α)and hypersensitive C-reactive protein(hs-CRP)in the observation group were lower than those in the control group after treatment,and the differences were statistically significant(P<0.05).The levels of forced expiratory volume in one second(FEV1)and forced expiratory volume in one second/forced vital capacity(FEV1/FVC)in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The SGRQ scores of the two groups were lower than those at 48 h and 7 d after treatment before treatment,the SGRQ score of the observation group was lower than that of the control group,and the differences were statistically significant(P<0.05).The total incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The application of pulmonary infection control window as the switching point can effectively reduce the inflammatory response,improve respiratory function and reduce the complications incidence with noninvasive-invasive ventilator sequentially.