有创—无创序贯通气治疗肺心病呼吸衰竭危重患者的效果及对相关指标的影响

Effect of invasive and noninvasive sequential ventilation on severe pulmonary heart disease respiratory failure and its effect on related indicators

目的观察有创一无创序贯通气应用于肺心病呼吸衰竭危重患者的效果及对相关指标的影响。方法选择2015年4月—2017年4月山东省禹城市人民医院急诊内科接受治疗肺心病呼吸衰竭危重患者80例作为研究对象,随机数字表法分成观察组和对照组各40例。2组患者均接受常规治疗,包括抗感染、化痰等。在此基础上,对照组患者行有创机械通气治疗,观察组患者则行有创—无创序贯通气治疗。观察、比较2组患者的临床治疗效果,治疗前后血气指标、呼吸频率(RR)、心率(HR)、心功能指标、血液流变学及安全性评价指标的变化情况。结果治疗后,观察组总有效率为92.5%,高于对照组的75.0%(X^2=4.501,P=0.034);观察组患者的有创通气时间及住ICU时间明显短于对照组(t=18.556、8.804,P均=0.000),而总通气时间差异无统计学意义(P>0.05);2组患者治疗2周后PaO_2、PaCO_2、pH水平均较治疗前显著改善,并且观察组患者改善更为明显(t=3.979、3.712、8.087,P均=0.000);2组患者治疗2周后HR、RR、LVEF、SV及mPVP水平均较治疗前显著改善,并且观察组患者改善的更为显著(t=4.602、4.049、4.318、5.764、8.122,P均=0.000);2组患者治疗2周后血浆黏度、全血高切黏度及全血低切黏度水平均较治疗前显著改善,并且观察组患者改善更为显著(t=6.369、24.241、9.344,P均=0.000);观察组患者的再插管率及呼吸机相关性肺炎(VAP)发生率明显低于对照组(X^2=4.114、3.914,P=0.043、0.048)。结论有创—无创序贯通气应用于肺心病呼吸衰竭危重患者治疗中,能够获得良好的临床效果,有效缩短有创通气时间、住ICU时间,改善血气、心功能及血液流变学指标,并且具有较高的安全性,值得加以推广应用。

Objective To investigate the effect of invasive and noninvasive sequential ventilation on severe pulmonary heart disease respiratory failure and its effect on related indicators. Methods Eighty cases of patients with severe pulmonary heart disease respiratory failure were selected, which were treated in hospital from April 2015 to April 2017, and they were divided into the observation group（40 case） and control group（40 cases）. The paticnts of two groups were all treated with conventional treatment, including anti-infection. phlegm and so on. The patients of control group were treated with invasive mechanical ventilation, while the. patients of observation grcoup were treated with invasive and noninvasive sequential ventilation. Observe and compare the clinical treatment effect, safety evaluation and the changes of heart rate（ HR）, respiratory rate（RR）, heart function index, blood gas index, hemorheology index levels of two groups. Results After the appropriate treatment, the patients of the observation group got a total effective rate of 92. 5%, which was significantly better than the 75. 0%of the control group（χ^2 =4. 501, P = 0. 034）; In the invasive ventilation time, and length of ICU stay, the observation group were significantly shorter than the control group（t = 18. 556, t =8. 804,P =0. 000, P =0.000）,but total. ventilation time has no significance（ P〉0. 05）; The PaO2, PaCO2, pH of the two groups were all significantly improved than before, and the patients of the control group got more significant improvement（t= 3. 979, t =3.712, t=8. 087, P = 0. 000, P =0. 000. P =0.000）; The HR, RR, LVEF, SV and mPVP levels of the two groups were all significantly improved than before, and the patients of the control group got more significant improvement（t= 4. 602,t= 4. 049.t = 4. 318,t = 5. 764,t= 8. 122,P =0.000, P= 0.000, P = 0.000, P= 0.000, P =0.000）; The plasma viscosity, whole blood high shear viscosity and whole blood low shear viscosity of the two groups were all significantly improved than before, and the patients of the control group got more significant improvement（t = 6.369, t = 24.241, t=9.344, P = 0. 000, P = 0.000, P = 0. 000）; The rate of re-intubation and ventilator associated pneumonia in the observation group were significantly lower than those in the control group（χ^2 =4.114, χ^2 =3.914, P=0.043, P =0.048）. Conclusion Invasive and noninvasive sequential ventilation in the treatment of severe pulmonary heart disease respiratory failure can achieve good clinical results, effectively shorten the invasive ventilation time and hospital stay, improve blood gas, heart function and hemorheology indicators, and it has a high degree of security,which makes it worthy of popularization and application.