序贯机械通气治疗重症肺炎合并呼吸衰竭35例的疗效分析

Analysis of therapeutic effect of sequential mechanical ventilation in the treatment of 35 severe pneumonia patients with severe respiratory failure

目的探讨序贯机械通气治疗重症肺炎合并呼吸衰竭的方法及疗效,并对在肺部感染控制窗到来时联合运用自主呼吸试验决定序贯机械通气切换点的可行性做初步探讨。方法采用回顾性对照研究,对接受序贯机械通气治疗的35例(治疗组)与同期接受传统机械通气治疗26例(对照组)重症肺炎患者疗效进行对比分析。记录两组患者出现肺部感染控制窗的时间、有创通气时间、总机械通气时间、ICU住院天数、住院死亡例数、再次插管例数等指标,并进行统计学分析比较。结果治疗组有创通气时间明显短于对照组,总机械通气时间也明显短于对照组,再次插管率低于对照组,ICU住院时间短于对照组(P均<0.05);住院病死率差异无统计学意义(P>0.05)。结论 (1)序贯机械通气治疗重症肺炎合并呼吸衰竭相比较传统机械通气治疗耐受性好,能明显缩短有创机械通气时间、总机械通气时间和ICU住院时间,降低再次插管率;(2)尚没有足够的证据表明序贯机械通气治疗重症肺炎合并呼吸衰竭能降低住院病死率;(3)以肺部感染控制窗联合自主呼吸试验为切换点行序贯机械通气是可行有效的。

Objective To investigate the effect of sequential mechanical ventilation in severe pneumonia patients with severe respiratory failure and the feasibility of the pulmonary-infection-control window （PIC） combined with spontaneous breathing trial （SBT）. Methods Some severe pneumonia patients with severe respiratory failure were analyzed retrospectively. These patients were divided into treated group （35 cases） and control group （26 cases）. The time of invasive and mechanical ventilation, days in ICU and condition of reintubation and nosoeomial death were studied. Results Compared with the control group, the time of invasive and mechanical ventilation, the condition of reintubation and days in ICU of treated group was decreased significantly. There was no significant difference in the total mortality between the two groups. Conclusion （ 1 ） The sequential mechanical ventilation was better than the conventional mechanical ventilation, because it can decrease the time of invasive and mechanical ventilation, the condition of reintubation and days in ICU; （2）There is no enough evidence that the sequential mechanical ventilation can decrease the total mortality; （3） The sequential mechanical ventilation in severe pneumonia patients withsevere respiratory failure and the application of the PIC combined with SBT was a feasible approach.