早期机械通气治疗脑卒中并发呼吸衰竭临床观察

Clinical observation of early mechanical ventilation in the treatment of stroke complicated with respiratory failure

目的评价早期机械通气治疗脑卒中并发呼吸衰竭患者的临床效果及其预后情况。方法选择驻马店市中心医院收治的68例脑卒中并发呼吸衰竭患者,按照随机数字表法分为A、B组,均采取降压、吸氧、预防感染及降低颅内压、调节水电解质紊乱等对症治疗。在以上治疗的基础上,A组采取常规机械通气治疗,B组根据患者的呼吸频率及动脉血氧饱和度情况采取早期机械通气治疗,对2组治疗前后血气分析指标及病情程度进行比较,随访6个月,对2组治疗前和随访6个月后的神经功能预后情况进行评价。结果 2组治疗后血气分析指标(PaO2、PaCO2、SaO2)水平、APACHⅡ评分及随访后6个月的神经功能预后指标(NDS、BI、FCA)各项评分均显著优于治疗前(P<0.05),且B组治疗后及随访6个月后的上述指标监测水平均显著优于A组(P<0.05)。结论早期机械通气治疗脑卒中并发呼吸衰竭较常规机械通气治疗的临床疗效显著,能够显著提高患者的血氧饱和度,减轻其低氧血症,有效改善神经功能预后情况。

Objective To evaluate the clinical effect and prognosis of early mechanical ventilation in the treatment of stroke complicated with respiratory failure.Methods Sixty-eight patients with stroke complicated with respiratory failure in Central Hospital of Zhumadian were divided into group A and B according to random number table.All patients were treated with decompression,oxygen inhalation,prevention of infection and reduction of intracranial pressure,regulation of water and electrolyte disorders,and other symptomatic treatment measures.On the basis of the above treatment,patients in group A were treated with conventional mechanical ventilation;patients in group B were treated with early mechanical ventilation according to respiratory frequency and arterial oxygen saturation.The blood gas analysis indexes and the degree of illness of the two groups before and after treatment were compared and analyzed.All patients were followed up for 6 months;the neurological function and prognosis of the two groups were evaluated before treatment and after 6 months of follow-up.Results The indexes of blood gas(PaO_2,PaCO_2,SaO_2)analysis,APACH Ⅱscore and neurological function prognosis index(NDS,BI,FCA)after 6 months of follow-up were significantly better than those before treatment in two groups(P<0.05),and the monitoring indexes of group B after treatment and after 6 months follow-up were significantly better than those in the group A(P<0.05).Conclusion Early mechanical ventilation is more effective than conventional mechanical ventilation in the treatment of stroke combined with respiratory failure,it can significantly improve the blood oxygen saturation,relieve hypoxemia,and effectively improve the prognosis of patients with neurological function.