高海拔地区无创正压通气治疗重症CAP合并呼衰的临床应用研究

Curative effects of early noninvasive positive pressure ventilation on severe community - acquired pneumonia and respiratory failure at high altitude area

目的探讨无创正压通气（NIPPV）在高海拔地区治疗重症社区获得性肺炎（CAP）合并呼吸衰竭的疗效。方法将海拔高度1500～3600m的169例社区获得性重症肺炎合并呼吸衰竭患者分为两组，99例早期接受NIPPV治疗者为治疗组，同时对痰量较多且黏稠者应用纤维支气管镜吸除气道分泌物、肺灌洗，并取深部分泌物或灌洗液行细菌培养加药敏试验治疗。70例拒绝NIPPV治疗者为对照组，比较两组患者治疗前后呼吸频率、血气分析变化、气管插管率、病死率及住院时间。结果治疗组治疗2h后PaO，较治疗前升高（P〈0．05）；治疗组治疗24h后呼吸频率、PaCO2较治疗前降低，pH、PaO2较治疗前升高（P〈0．01）；治疗组治疗24h后PaO2较对照组升高（P〈0．01）。治疗组气管插管率、病死率、住院时间明显低于对照组（P〈0．01）。结论在高海拔地区早期应用NIPPV联合纤维支气管镜治疗技术是治疗重症CAP合并呼吸衰竭的有效手段，可显著改善患者的预后，降低病死率，且是有效遏制重症CAP并呼吸衰竭引向多脏器功能障碍综合征（MODS）的一项重要措施，值得临床推广应用。

Objective To study the curative effect of early noninvasive positive pressure ventilation（NIPPV） on severe community - acquired pneumonia（CAP） patients with respiratory failure at high altitude area. Methods Patients were divided into study group and control group. The patients received NIPPV combined with bronchoseope besides conventional treatment for the study group, the other patients were treated with only conventional treatment as control group. Respiratory rate, the changes of arterial blood gases, intubation rate, mortality and days in the hospital were compared in two groups. Results The PaO2 in study group after 2 - hour treatment was higher than that in control group （ P 〈 0.05 ）. The respiratory rate and PaCO2 24 hours after treatment in study group were lower than those in control group. The pH and PaO2 24 hours after treatment were higher than those in control group（ P 〈 0.01 ）. The intubation rate, mortality and days in hospital in study group were lower than those in control group （ P 〈 0.01 ）. Conclusion Early NIPPV and bronchoscope are effective therapy for severe CAP patients with respiratory failure at high altitude area. It can improve artery blood gases and dyspnea markedly, and decrease intubation rate,the days in hospital and mortality. The early use of NIPPV might effectively prevent severe CAP patients with respiratory failure from the exacerbation of MODS.