序贯机械通气治疗中间综合征效果分析

Effect of Sequential Mechanical Ventilation in the Treatment of Intermediate Syndrome

目的探讨有创-无创序贯机械通气应用于急性有机磷农药中毒(AOPP)所致的中间综合征(IMS)治疗效果。方法回顾性分析我院76例中间综合征患者应用机械通气治疗效果,病例资料分为常规治疗组(对照组)和有创-无创序贯治疗组(序贯组)。对照组以常规有创机械通气方式进行机械通气和脱机;序贯组以IMS控制窗为切换点停有创机械通气,改为无创正压通气(NPPV)。比较两组总机械通气时间、住ICU时间、呼吸机相关性肺炎(VAP)发生率、再插管率和院内死亡率。结果对照组36例,序贯组40例,对照组和序贯组的总机械通气时间为(12.58±4.49)d和(10.02±1.68)d,住ICU时间为(20.67±4.38)d和(14.11±2.91)d,VAP发生率为72.22%(26/36)和40.00%(16/40),再插管率为27.78%(10/36)和10%(4/40),院内死亡率为47.22%(17/36)和25%(10/40),两组比较差异均有统计学意义(P<0.05)。结论序贯机械通气应用于中间综合征可以缩短总机械通气时间、住ICU时间,降低VAP发生率和住院死亡率。

Objective To explore the therapeutic effect of invasive-noninvasive sequential mechanical ventilation in the treatment of intermediate syndrome（IMS）caused by acute organophosphorus pesticide poisoning（AOPP）. Methods Retrospec- tive analysis of therapeutic effect of 76 cases of intermediate syndrome patients treated by mechanical ventilation. Case data were divided into the conventional treatment group （ control group） and invasive-noninvasive sequential treatment group （ sequential group）. Control group conducted mechanical ventilation and weaning in conventional invasive mechanical ventilation mode; se- quential group took IMS control window as the switch point to change from invasive mechanical ventilation to non-invasive positive pressure ventilation（NPPV）. The total mechanical ventilation time, ICU time, ventilator-associated pneumonia（VAP） , reintuba- tion rates and hospital mortality were compared between the two groups. Results There were 36 cases in control group, 40 cases in sequential group. The total mechanical ventilation time of the control group and the sequential group was（ 12. 58 ＋ 4.49 ） d and （ 10. 02 ＋ 1.68 ）d, the ICU time was （20. 67 ＋ 4. 38 ）D and （ 14. 11 ＋ 2. 91 ）d, VAP was 72. 22% （26/36）and 40% （ 16/40）, the reintubation rates were 27.78% （10/36）and 10% （4/40）, and the hospital mortality rates were 47.22% （17/36）and 25%（ 10/40）, respectively. The differences between the two groups were all statistically significant （P 〈 0.05 ）. Conclusion Sequential mechanical ventilation applied to intermediate syndrome can shorten the total mechanical ventilation time and ICU time as well as re- duce the incidence of VAP and mortality.