无创正压通气配合气管内留置吸痰管吸痰在脑血管疾病合并重症肺炎患者中的治疗探讨

Noninvasive Bi-level Positive Airway Pressure Ventilation Combined Endotracheal Detaining Suction Catheter for Sputum Aspiration in Cerebrovascular Disease Patients with Severe Pneumonia

目的研究无创双水平正压通气(BiPAP)配合气管内留置吸痰管吸痰在脑血管疾病合并重症肺炎患者中的治疗效果。方法 67例脑血管疾病合并重症肺炎患者分为A、B两组,A组32例拒绝气管插管的患者采用无创双水平正压通气配合气管内留置吸痰管吸痰进行治疗,B组35例采用经口气管插管机械通气进行治疗,观察两组的治疗效果。结果两组患者呼吸支持治疗1h后氧合均得到明显改善;A组患者呼吸支持时间为(122.8±38.3)h,明显少于B组的(268.4±93.2)h;A组患者住院时间为(16.8±7.4)d,明显少于B组的(26.3±9.8)d;A组、B组死亡率分别为25.0%、22.9%,两组患者死亡率比较差异无统计学意义(P>0.05)。结论对于拒绝气管插管的脑血管疾病合并重症肺炎患者来说,无创正压通气配合气管内留置吸痰管吸痰治疗是一种比较好的选择。

Objective To study the effects of noninvasive bi - level positive airway pressure （BiPAP） ventilation combined endotracheal detaining suction catheter for sputum aspiration in patients with eerebrovaseular disease complicated by severe pneumonia. Methods Totally 67 eerebrovascular disease patients with severe pneumonia were divided into group A （32 cases） and group B （35 cases）. The patients who refused endotracheal intubation in group A were received noninvasive BiPAP ventilation and endotracheal detaining suction catheter for sputum aspiration. The patients in group B were treated by perioral endotracheal intubation - mechanical ventilation. The effects of the treatments were investigated. Results After one hour respiratory support, the oxygenation improved significantly in both group A and group B. The patients in group A had a significantly shorter duration of respiratory support than patients in group B [ （ 122. 8 ± 38.3 ） versus （268.4 ± 93.2） hours] （P 〈 0. 01 ）. The hospital stay of Group A was shorter than that of Group B [ （ 16. 8 ± 7.4） versus （26. 3 ± 9. 8 ） days ] （P 〈 0. 01 ）. No significant difference was found in the mortality rates between the two groups （ P 〉 0. 05 ） . Conclusion To eerebrovascular disease patients with severe pneumonia who refuse endotracheal intubation, noninvasive BiPAP ventilation combined endotracheal detaining suction catheter for sputum aspiration is a good choice.