早期采用无创正压通气联合纤维支气管镜治疗社区获得性重症肺炎并发呼吸衰竭的临床研究

Clinical study of treatment of severe community-acquired pneumonia with respiratory failure by early noninvasive prositive pressure ventilation combined with bronchoscope

目的观察早期采用无创正压通气联合纤维支气管镜(简称纤支镜)治疗社区获得性重症肺炎并发呼吸衰竭的疗效。方法将社区获得性重症肺炎并发呼吸衰竭早期的患者分为接受早期无创正压通气联合纤支镜治疗组(治疗组)和拒绝接受无创通气及纤支镜治疗组(对照组),比较两组病例治疗前后的呼吸频率变化、血气分析变化、首次痰培养阳性率、气管插管率、呼吸重症监护病房(R ICU)住院时间和病死率。结果治疗组治疗2h PaO2升至(74±11)mm Hg,至24h达(75±10)mm Hg,对照组分别为(49±11)mm Hg、(51±8)mm Hg,两组差异有统计学意义(P<0.01)。治疗组24h后呼吸频率为(30±5)次/m in,pH值为7.38±0.10,PaCO2为(46±10)mm Hg,对照组分别为(37±5)次/m in、7.30±0.12、(59±8)mm Hg,两组比较差异有统计学意义(P<0.05)。治疗组和对照组的首次痰培养阳性率分别为60.0%和33.3%、气管插管率为24%和57.14%、R ICU住院时间为(13±4)d和(16±4)d、病死率为12%和42.86%,两组指标比较差异均有统计学意义(P<0.05)。结论早期采用无创正压通气联合纤支镜技术是治疗社区获得性重症肺炎并发呼吸衰竭的有效手段,能迅速改善动脉血气、缓解呼吸困难,减少气管插管率,降低病死率,减少ICU住院时间,改善预后。

Objective To observe the efficacy of early noninvasive hi -level prositive airway pressure （BiPAP） ventilation combined with bronchoscope in severe community -acquired pneumonia （CAP） with respiratory faihtre. Methods The cases were divided into the study group and the control group. The patients received early noninvasive BiPAP ventilation combined with bronchoscope base on conventional treatment as the study group, the others were treated with only conventional therapy as control group. Variety of respiratory rate ,arterial blood gases exchange,positive rate of first -time sputum cuhttre,intubation rate, the duration of RICU stay and mortality rate were measured after therapy. Results For the study group and the control group, PaO2 in 2 hours after therapy was （74 ± 11 ） vs （49 ± 11 ）, PaO2 in 24 hours was （75 ± 10）mm Hg vs （51 ± 8 ）mm Hg, （ P 〈 0.01 ）. Respiratory rate at 24 hours after therapy was （30 ±5） times/min vs （37 ±5） times/rain, pH and PaCO2 in 24 hours after therapy were 7.38 ±0. 10 and （46 ± 10）mm Hg vs 7.30 ±0. 12、（59 ±8） mm Hg, positive rate of first -time sputum culture was 60.0% vs 33.3%, intubation rate was 24% vs 57.14%, the duration of RICU stay was （13 ±4） days vs （ 16 ± 4） days,mortality rate was 12% vs 42.86%, there was a significant difference in the two groups （ P 〈 0.05 ）. Conclusion The therapy of early noninvasive BiPAP ventilation combined with bronchoscope is effective in severe CAP with respiratory failure. It can improve artery blood gases and dyspnoea markedly,decrease intubation rate , the duration of RICU stay and mortality rate.