无创正压机械通气辅助治疗重症肺炎合并呼吸衰竭效果分析

Effect of Non-invasive Positive Pressure Ventilation Treatment of Severe Pneumonia Combined with Acute Respiratory Failure

目的探讨无创正压机械通气辅助治疗重症肺炎合并急性呼吸衰竭的疗效。方法选取2012年1月至2014年12月在临高县人民医院呼吸内科就诊的70例重症肺炎合并呼吸衰竭患者，采用随机数字表法将患者随机分为有创组和无创组，每组35例。有创组患者在常规治疗的基础上给予有创机械通气治疗[压力支持通气调节为5～10emil20（1emil20=0．098kPa），呼气终末正压为3～5cmH20]，而无创组则给予无创正压机械通气治疗（呼吸频率为12～18次，吸气压力调节为8～22emH20，呼气压力为4～6emil20，吸氧流量设为4～6L／rain）。比较两组患者治疗后的生命体征、血气分析指标及转归情况。结果无创组患者的心率、呼吸频率低于有创组[（86．5±8．4）次／min比（96．7±11．0）次／rain、（23．7±3．1）次／min比（28．6±4．3）次／min]，氧分压、血氧饱和度高于有创组l（83．7±10．4）mmHg（1mmHg=0．133kPa）比（65．2±8．9）mmHg、（94．1±6．9）％比（85．8±5．2）％]（P〈0．01），而二氧化碳分压明显低于有创组[（42．6±6．0）mmHg比（50．8±5．5）mmHg]，差异有统计学意义（P〈0．01）；无创组患者的通气时间、APACHE11评分、住院时间少于有创组[（12．0±3．6）d比（15．6±4．3）d、（11．4±2．9）分比（16．3±3．5）分、（13．8±5．0）d比（22．5±6．2）d]，差异均有统计学意义（P〈0．01）；无创组患者的住院病死率为8．5％（3／35），有创组为20．0％（7／35），两者比较差异无统计学意义（P〉0．05）。结论无创正压机械通气辅助治疗重症肺炎合并呼吸衰竭，可调整患者的心率和呼吸频率，有效缓解患者的缺氧状态，改善患者预后情况，效果较有创机械通气治疗好。

Objective To explore the effect of non-invasive positive pressure ventilation on treating severe pneumonia combined with acute respiratory failure. Methods Total of 70 cases of severe pneumonia combined with acute respiratory failure in Department of Respiratory Medicine ,Lingao County People＇s Hos- pital from Jan. 2012 to Dec. 2014 were selected and then randomly divided into invasive group and non-inva- sive group according to random number table method ,35 cases in each group. The invasive group was given invasive mechanical ventilation （ pressure support ventilation 5-10 cmH2O, positive end-expiratory pressure 3-5 cmH2O） on the basis of conventional therapy, and the non-invasive group was given non-invasive positive pressure ventilation （ breathing frequency 12-18 tims/min,inspiratory pressure 8-22 cmH2O, expiratory pres- sure 4-6 cmH2O, oxygen flow 4-6 L/mln）. The indexes of vital sign, blood gas analysis index and prognosis were compared between the two groups after treatment. Results The heart rate and breathing rate of the non- invasive group were much lower than those of the invasive group [ （ 86. 5 ± 8. d ） times/min vs （96. 7 ± 11. 0） times/min, （23.7 ± 3.1 ） times/min vs （ 28.6 ±4. 3 ） times/min ] （ P 〈 0.05 ）, partial pressure of oxygen and blood oxygen saturation of the non-invasive group were much higher than the invasive group [ （ 83.7 ± 10.4） mmHgvs （65.2 ±8.9） mmHg,（94.1 ±6.9）% vs （85.8 ±5.2）%] （P〈0.05）,but partial pressure of carbon dioxide was much lower than the invasive group [ （42.6 ± 6.0） mmHg vs （ 50. 8 ±5.5 ） mmHg] （P 〈0.05 ）. The duration of ventilation, APACHE Ⅱ and length of stay of the non-invasive group were much lower than the invasive group [ （ 12. 0 ± 3.6 ） d vs （ 15.6 ± 4.3 ） d, （ 11.4 ± 2. 9 ） scores vs （16.3 ±3.5） scores,（13.8 ±5.0） d vs （22.5±6.2） dl （P 〈0.01） ,the hospital mortality of the noninvasive group was 8.5 % （3/35）, of the invasive group was 20. 0% （7/35）, the difference was not statisti- cally significant（ P 〉 0. 05 ）. Conclusion Invasive positive pressure ventilation can be used for treatment of severe pneumonia combined with acute respiratory failure patients, which can adjust heart rate and breathing frequency,relieve hypoxia state and improve prognosis of the patients, and is better than invasive positive pressure ventilation.