单纯有创和有创-无创序贯机械通气治疗ICU慢性肺心病急性期合并Ⅱ型呼吸衰竭患者疗效的对比分析

Comparison and analysis of invasive and invasive/noninvasive sequential mechanical ventilation in the treatment of ICU patients with acute chronic pulmonary heart disease complicated with type Ⅱ respiratory failure

目的旨在对比分析单纯有创和有创-无创序贯机械通气治疗ICU慢性肺心病(chronic pulmonary heart disease,CCPD)急性期合并Ⅱ型呼吸衰竭患者的疗效。方法选取我院ICU室于2013年1月至2016年6月收治的CCPD合并呼吸衰竭患者120例作为研究对象,经知情同意,采用数字表法分为有创组(60例)和有创-无创组(60例)。有创组接受单纯有创机械通气,有创-无创组接受有创-无创序贯机械通气。分析比较2组患者呼吸机相关性肺炎(ventilator associated pneumonia,VAP)发病率、再插管率和病死率、ICU治疗时间、机械通气时间及有创通气时间;观察比较2组患者治疗前、后BR、肺动脉收缩压(SBP)以及血气分析(p H值、Pa O2、Pa CO2)等指标;测定和比较治疗前、后2组患者血清B型尿钠肽(BNP)、内皮素(ET)和血管紧张素Ⅱ(Ang-Ⅱ)表达;观察和比较2组患者并发症发生情况。结果有创-无创组患者VAP发病率、再插管率和病死率均低于有创组患者(P<0.05)。有创-无创组患者ICU治疗时间、机械通气时间及有创通气时间均低于有创组患者(P<0.05)。2组患者BR、SBP以及血气分析指标差异无统计学意义(P<0.05)。有创-无创组BNP、ET、Ang-II表达低于有创组(P<0.05)。有创-无创组患者并发症发生率为13.33%低于有创组患者的58.33%,差异有统计学意义(P<0.05)。结论有创-无创序贯性机械通气治疗CCPD合并呼吸衰竭,可改善患者通气功能,安全性高,值得临床推广。

Objective To compare and analyze the efficacy of simple invasive and invasive/noninvasive sequential mechani-cal ventilation in the treatment of ICU patients with chronic pulmonary heart disease （CPHD） complicated with type II respiratory fail-ure. Methods One hundred and twenty cases of CPHD combined with respiratory failure admitted into the ICU of our hospital for treat-ment from January 2013 to June 2016 were selected as research subjects, and were divided into the invasive group （60 cases） and the invasive-noninvasive group （60 cases）. The invasive group received simple invasive mechanical ventilation, while the invasive/nonin-vasive group received invasive and noninvasive sequential mechanical ventilation. Then, analyses and comparisons were made in the in-cidence of ventilator-associated pneumonia （VAP） , reintubation rate and mortality, ICU treatment time, mechanical ventilation time and invasive ventilation time between the patients of the 2 groups. Indexes such as BR, pulmonary artery systolic blood pressure （SBP） , blood gas analyses （ pH, Pa0 2, PaCO2） and other indexes both before and after treatment were closely observed and compared between the patients of the 2 groups. The expression levels of serum B type natriuretic peptide （BNP） , endothelin （ET） and angiotensin II （ Ang-II） both before and after treatment were detected and compared between the patients of the 2 groups. The incidence of com-plications in the patients of the 2 groups was also observed and compared. Results The incidence of VAP, reintubation rate and mortal-ity of the invasive/noninvasive group were significantly lower than those of the invasive group （ P 〈 0. 05 ） . The duration of ICU treat-ment ,mechanical ventilation time and invasive ventilation time of the invasive/noninvasive group were all significantly shorter than those of the invasive group （P 〈0. 0 5 ） . There was no statistical significance in the indexes of BR, SBP and blood gas analysis, when com-parisons were made between the 2 groups （P 〈0. 0 5 ） . The expression levels of BNP, ET and Ang-II in the invasive/noninvasive group were significantly lower than those in the invasive group （P 〈0.05）. The incidence of complication in the invasive/noninvasive group （13.33%） was significantly lower than that in the invasive group （58. 33% ） （ P 〈0. 01） . Conclusion Invasive/noninvasive sequen-tial mechanical ventilation in the treatment of CPHD combined with respiratory failure could improve the ventilation function of patients with high safety, and it was worth further clinical extension.