序贯性机械通气策略治疗外科急性呼吸衰竭的效果

Sequential invasive-noninvasive mechanical ventilation for surgical acute respiratory failure

目的评价有创-无创序贯性机械通气治疗外科急性呼吸衰竭(acute respiratory failure,ARF)的临床效果。方法以2010年10月至2011年11月收住我院ICU的126例外科ARF行气管插管和机械通气者为研究对象,前瞻性随机分为两组,每组63例。达到序贯切换点后,序贯组拔除气管插管,应用无创机械通气支持直至脱机;常规组则继续有创机械通气,以常规方式脱机。结果两组患者在治疗前,APACHEⅡ评分、呼吸频率、心率、平均动脉压、动脉血pH值及氧合指数等指标相似(P>0.05)。序贯组和常规组呼吸机相关肺炎(ventilationassociated pneumonia,VAP)发生率分别为15.9%和42.9%(χ2=17.387,P<0.001)。序贯组有创机械通气时间为(8±3)d,而常规组为(24±12)d[(t=9.673,P<0.001)]。序贯组总机械通气时间为(16±6)d,而常规组为(24±12)d(t=8.896,P<0.001)。序贯组住ICU时间为(17±5)d,而常规组为(26±11)d[(t=6.879,P<0.001)]。结论对外科ARF患者,采用有创-无创序贯性治疗策略,可以降低VAP患病率,缩短有创机械通气时间、总机械通气时间和住ICU时间。

Objective To evaluate the clinical efficacy of sequential invasive-noninvasive mechanical ventilation （SINMV） in treatment of surgical acute respiratory failure （ARF）. Methods One hundred and twenty six ARF patients due to surgery diseases were admitted in intensive care unit （ICU） and underwent tracheal intubation and invasive mechanical ventilation （MV） from October 2010 to November 2011 ; the patients were randomly divided into two groups with 63 cases in each. When the switch point was achieved, patients in sequential group accepted noninvasive MV and intubations were removed. Those in routine group continually accepted invasive MV and disconnect MV with routine mode. Results There were no significant differences in APACHE Ⅱ scores,respiratory rate, heart rate, mean arterial blood pressure, pH of arterial blood and oxygenation index between the two groups （ all P 〉 0.05 ）. The incidence of ventilation associated pneumonia （VAP） in sequential and routine groups was 15.9% and 42.9%, respectively （X2 = 17. 387, P 〈0.001 ）. The duration of invasive MV was （ 8 ± 3 ） d and （24 ± 12） d; the total duration of MV was （ 16 ± 6） d and （24 ± 12） d, and duration of ICU stay was （17 ±5） d and （26 ± 11）d, respectively （t =9. 673, 8. 896 and 6. 879, respectively, all P 〈 0. 001 ）. Conclusion Compared with routine MV, SNIMV may decrease the prevalence of VAP and shorten the duration of invasive MV, total MV and ICU stay in the patients with ARF due to surgery diseases.