序贯机械通气治疗重症肺炎的临床研究

Clinical research of sequential mechanical ventilation in the treatment of severe pneumonia

目的探讨有创序贯无创机械通气在重症肺炎治疗中的应用效果。方法选取我院收治的需经气管插管机械通气重症肺炎患者50例,随机分为观察组和对照组各25例。两组患者均按照重症肺炎进行常规药物治疗及有创机械通气治疗。对照组在病情改善后逐渐调低呼吸机参数至撤机,观察组在出现肺部感染控制窗后,拔管改用无创通气辅助呼吸治疗,对比两组患者的有创机械通气时间、总机械通气时间、呼吸机相关肺炎发生率、病死率以及再插管的情况。结果两组患者的出窗时间,出窗时的呼吸频率、心率、收缩压、舒张压、二氧化碳分压以及氧合指数的对比,差异均没有统计学意义(均P>0.05);观察组患者无创呼吸前和无创呼吸后2小时的呼吸频率、心率、收缩压、舒张压、二氧化碳分压和氧合指数的对比,差异均没有统计学意义(均P>0.05);观察组的有创通气时间为(6.68±1.81)d,总机械通气时间为(11.08±2.92)d,呼吸机相关肺炎的发生率为4.00%,均显著少于对照组(均P<0.05)。结论重症肺炎行序贯机械通气治疗可有效缩短患者的有创机械通气时间,降低呼吸机相关肺炎的发生率。

Objective To investigate the effect of sequential mechanical ventilation in the treatment of severe pneumonia. Methods 50 patients with severe pneumonia were randomly divided into observation group and control group with 25 cases in each. The control group reduced ventilator parameters to weaning after the condition improved gradually. After the presence of pulmonary infection control window,extubating noninvasive ventilationto assisted respiratory therapy. Invasive mechanical ventilation time,total time of mechanical ventilation and ventilator associated pneumonia incidence,mortality and re- intubation conditions of the two groups were compared. Results The differences of the time out of the window,respiratory frequency,heart rate,systolic pressure,diastolic pressure,partial pressure of carbon dioxide contrast and oxygenation index window between the two groups were not statistically significant（ P〉0. 05）. The differences of respiratory frequency of patients with noninvasive breathing and non- invasive ventilation after 2 hours of observation group,the heart rate,systolic and diastolic blood pressure,partial pressure of carbon dioxide and oxygen index contrast were not statistically significant（ P〉0. 05）. Invasive ventilation time in observation group was（ 6. 68 ± 1. 81） d,the total mechanical ventilation time was（ 11. 08 ± 2. 92） d,ventilator related pneumonia occur rate was 4%,these were significantly less than the control group（ all P〈0. 05）. Conclusions Sequential mechanical ventilation in the treatment of severe pneumonia can effectively shorten invasive mechanical ventilation time,reduce the incidence of ventilator associated pneumonia.