有创-无创序贯机械通气在肺挫伤致急性呼吸衰竭中的应用效果分析

Clinical effect and application value of sequential invasive to noninvasive mechanical ventilation in treatment of acute respiratory failure which caused by pulmonary contusion

目的探讨有创-无创序贯机械通气对肺挫伤致急性呼吸衰竭救治中的临床效果和应用价值。方法选择我院2013年1月至2014年12月收治的肺挫伤致急性呼吸衰竭患者42例,根据不同机械通气方法分为试验组和对照组,试验组采用有创-无创序贯机械通气,对照组采用持续有创机械通气,比较两组患者的治疗情况:总机械通气时间、有创通气时间、ICU入住时间、呼吸机相关性肺炎(VAP)发生率、撤机成功率、住院死亡率等,以及呼吸与血气相关指标。结果试验组的总机械通气时间、有创通气时间、ICU入住时间均短于对照组,差异有统计学意义(P<0.05)。试验组呼吸机相关性肺炎(VAP)发生率、住院死亡率明显低于对照组,而撤机成功率高于对照组,差异有统计学意义(P<0.05)。试验组PaCO_2、心率和呼吸频率低于对照组,而pH值、PaO_2、SaO_2高于对照组,差异有统计学意义(P<0.05)。结论有创-无创序贯机械通气治疗在肺挫伤致急性呼吸衰竭救治中,能有效减少总机械通气时间和有创通气时间,降低VAP发生率和住院死亡率,提高撤机成功率和治疗效果,具有很高的临床应用与推广价值。

Objective To study the clinical effect and application value of sequential invasive to noninvasive mechanical ventilation in the treatment of acute respiratory failure which caused by pulmonary contusion. Methods In our hospital from January 2012 ~ December 2014,42 cases of acute respiratory failure which caused by pulmonary contusion were observed. According to different mechanical ventilation,cases were divided into experimental group and control group. The experimental group used sequential invasive to noninvasive mechanical ventilation,the control group adopted continuous invasive mechanical ventilation. Compared the situation of treatment in two groups ： The total time of mechanical ventilation,invasive ventilation time,ICU stay time,the incidence of ventilator associated pneumonia（ VAP）,success rate of ventilator,in-hospital mortality and so on; as well as breathing,blood gas related index. Results The total time of mechanical ventilation,invasive ventilation time and ICU stay time of experimental group were shorter than these of control group,significant difference between the two groups（ P〈0. 05）. The incidence of VAP and in-hospital mortality in the experimental group were significantly lower than these of control group,but success rate of ventilator was higher than the control group,the difference was statistically significant（ P〈0. 05）. PaCO_2,HR,R of experimental group were lower than these in control group,pH,PaO_2,SaO_2 were higher than the control group,there was significant difference between the two groups（ P〈0. 05）. Conclusions The sequential invasive to noninvasive mechanical ventilation in the treatment of acute respiratory failure which caused by pulmonary contusion,can effectively reduce total time of mechanical ventilation and invasive ventilation time,reduce the incidence of VAP and in-hospital mortality,as well as improve the success rate of ventilator and healing,has great value in clinical application and promotion.