有创-无创序贯机械通气治疗ICU慢性肺心病急性期合并Ⅱ型呼吸衰竭患者的疗效分析

Analysis on curative effect of invasive and non-invasive sequential mechanical ventilation in treatment of ICU patients with acute chronic pulmonary heart disease combined with type Ⅱ respiratory failure

目的探讨有创-无创序贯机械通气治疗ICU慢性肺源性心脏病(肺心病)急性期合并Ⅱ型呼吸衰竭患者的疗效。方法选取2016年7月至2017年7月该院收治的慢性肺心病患者100例,并按随机区组法分为对照组和观察组,每组50例。两组均进行机械通气,观察组使用有创-无创序贯机械通气治疗,对照组使用单纯有创机械通气治疗,比较两组呼吸机相关性肺炎(VAP)发生率、再插管率、病死率、ICU治疗时间、机械通气时间、有创机械通气时间、血气分析结果、心律和肺动脉压、B型尿钠肽(BNP)、内皮素(ET)和血管紧张素Ⅱ(Ang-Ⅱ)水平变化。结果观察组VAP发生率、再插管率、病死率明显低于对照组,且有创机械通气时间、ICU治疗时间及机械通气时间明显短于对照组,差异均有统计学意义(P<0.05);观察组治疗后血气分析结果及心率、肺动脉压水平与观察组相近,差异均无统计学意义(P>0.05);观察组治疗后BNP、ET和Ang-Ⅱ水平明显低于对照组,差异均有统计学意义(P<0.05)。结论有创-无创序贯机械通气治疗慢性肺心病急性期合并Ⅱ型呼吸衰竭疗效显著,值得临床推广。

Objective To explore the curative effect of invasive and non？invasive sequential mechanical ventilation intreatment of ICU patients with acute chronic pulmonary heart disease combined with type Ⅱ respiratory failure.Methods 100patients with chronic pulmonary heart disease admitted in the hospital from July 2016 to July 2017 were randomly divided intothe control group and observation group,50 cases in each group.The two groups were treated with mechanical ventilation.The ob？servation group was treated with invasive and non？invasive sequential mechanical ventilation,while the control group was treatedwith invasive mechanical ventilation only.The ventilator？associated pneumonia（VAP）incidence,reintubation rate,mortality,ICU treatment time,mechanical ventilation time,invasive mechanical ventilation time,blood gas analysis result,cardiac rhythm and pulmonary arterial pressure,B type natriuretic peptide（BNP）,endothelin（ET）and angiotensin Ⅱ（Ang？Ⅱ） of the two groups were compared.Results The VAP incidence,the re intubation rate and the mortality rate of the observation group were significantly lower than those in the control group,and the mechanical ventilation time,the ICU treatment time and the mechani？cal ventilation time were significantly shorter than those in the control group,and the difference was statistically significant（P〈0.05）;the results of blood gas analysis,the heart rate and the pulmonary artery pressure in the observation group were similar tothose in the observation group,and the difference was not statistically significant（P〉0.05）;the levels of BNP,ET and Ang？ II in the observation group were significantly lower than those in the control group after treatment,and the difference was statisticallysignificant（P〈0.05）.Conclusion The invasive and non？invasive sequential mechanical ventilation in the treatment of chronicpulmonary heart disease at acute stage combined with type II respiratory failure is effective and worthy of clinical promotion.