无创正压通气联合纤维支气管镜吸痰在重症社区获得性肺炎治疗中的应用效果

Effect of Non-Invasive Positive Pressure Ventilation Combined Fiberbronchoscopic Sputum Suction on Severe Community-Acquired Pneumonia

目的探讨无创正压通气(NIPPV)联合纤维支气管镜吸痰在重症社区获得性肺炎(community-acquired pneumonia,CAP)治疗中的应用效果。方法将46例重症CAP患者按治疗方法不同分为对照组与观察组,每组23例。2组均行抗感染、化痰、吸氧、纠正水电解质紊乱、营养支持等常规治疗,同时给予NIPPV治疗;观察组在此基础上给予纤维支气管镜吸痰治疗。观察2组治疗前及治疗后12、24、48h动脉血血气分析指标(pH、PaO2和PaCO2)及氧合指数(PaO2/FiO2)的变化情况;比较2组治疗期间中转气管插管率及治疗后脱离呼吸机时间、住院时间。结果观察组中转气管插管率、脱离呼吸机时间和住院时间均较对照组显著减少(P<0.05或P<0.01)。2组治疗前后pH、PaCO2值比较差异均无统计学意义(P>0.05);2组治疗后各时段PaO2、PaO2/FiO2值较较治疗前显著升高(P<0.01),观察组治疗后各时段PaO2、PaO2/FiO2值均对照组改善更为显著(P<0.01)。结论 NIPPV联合纤维支气管镜吸痰治疗重症社区获得性肺炎能迅速改善低氧血症,减少气管插管率,缩短脱离无创呼吸机时间和住院时间。

Objective To investigate the effect of non-invasive positive pressure ventilation(NIPPV)combined fiberbronchoscopic sputum suction on severe community-acquired pneumonia(CAP).Methods Forty-six patients with severe CAP received anti-infection,dispersing phlegm,oxygen inhalation,correction of fluid and electrolyte imbalances,nutritional support,and other conventional therapies.In addition,these patients were treated with NIPPV alone(control group,n=23)or in combination with fiberbronchoscopic sputum suction(observation group,n=23).Arterial blood gas analysis indicators(pH,PaO2,PaCO2)and oxygenation index(PaO2/FiO2)were measured before treatment and at 12,24 and 48 hours after treatment.The rate of conversion to endotracheal intubation,time of off-ventilator and length of hospital stay were compared between the two groups.Results Compared with control group,the rate of conversion to endotracheal intubation,time of off-ventilator and length of hospital stay significantly decreased in observation group(P<0.05 or P<0.01).There were no differences in pH and PaCO2 between the two groups before treatment(P>0.05).After treatment,the PaO2 and PaO2/FiO2 were improved in both groups,and the improvement in observation group was more obvious than that in control group(P<0.01).Conclusion The combination of NIPPV and fiberbronchoscopic sputum suction can rapidly improve arterial hypoxemia,reduce endotracheal intubation rate,and shorten off-ventilator time and hospital stay in patients with severe CAP.