无创正压通气联合自制痰液吸取装置在老年重症肺炎合并呼吸衰竭患者中的应用效果

Application Effect of Non-invasive Positive Pressure Ventilation Combined with Self-made Sputum Suction Device in Elderly Severe Pneumonia Patients Complicated with Respiratory Failure

目的评价无创正压通气(NIPPV)联合自制痰液吸取装置在老年重症肺炎合并呼吸衰竭患者中的应用效果。方法选取2015年5月—2017年10月上海市杨浦区市东医院重症医学科收治的老年重症肺炎合并呼吸衰竭患者66例,采用随机数字表法分为对照组32例和治疗组34例。对照组患者采用气管插管或气管切开有创正压通气(IPPV)联合常规吸痰治疗,治疗组患者采用NIPPV联合自制痰液吸取装置治疗。比较两组患者治疗前和治疗后24 h心率(HR)、动脉血气分析指标,呼吸支持时间、单次吸痰量、24 h吸痰量、24 h吸痰次数、气管切开率、重症监护室(ICU)入住时间,治疗前和治疗后28 d急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和肺炎严重指数(PSI)评分,治疗后28 d内病死率及并发症发生情况。结果两组患者治疗前和治疗后24 h HR、p H值、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、动脉血氧饱和度(Sp O2)比较,差异无统计学意义(P>0.05)。治疗组患者呼吸支持时间、ICU入住时间短于对照组,单次吸痰量、24 h吸痰量多于对照组,24 h吸痰次数少于对照组,气管切开率低于对照组(P<0.05)。两组患者治疗前APACHEⅡ评分和PSI评分比较,差异无统计学意义(P>0.05);治疗后28 d,治疗组患者APACHEⅡ评分和PSI评分低于对照组(P<0.05)。两组患者治疗后28 d内病死率比较,差异无统计学意义(P>0.05)。治疗组患者治疗后28 d内呼吸机相关性肺炎(VAP)发生率低于对照组(P<0.05)。结论 NIPPV联合自制痰液吸取装置能有效提高老年重症肺炎合并呼吸衰竭患者吸痰效果,减轻患者痛苦,改善患者预后,降低VAP发生率。

Objective To evaluate the application effect of non-invasive positive pressure ventilation(NIPPV)combined with self-made sputum suction device in elderly severe pneumonia patients complicated with respiratory failure.Methods From May 2015 to October 2017,a total of 66 elderly severe pneumonia patients complicated with respiratory failure were selected in the Department of Critical Care Medicine,City East Hospital of Yangpu District,Shanghai,and they were divided into control group(n=32)and treatment group(n=34)according to random number table.Patients in control group received endotracheal intubation or tracheal incision guided invasive positive pressure ventilation combined with conventional sputum suction,while patients in treatment group received NIPPV combined with self-made sputum suction device assisted sputum suction.Observation index was compared between the two groups,including heart rate,arterial blood-gas analysis index before treatment and 24 hours after treatment,breathing support time,once sputum suction volume,24-hour sputum suction volume,24-hour sputum suction times,tracheotomy ratio and ICU stays,APACHEⅡscore and Pneumonia Severity Index(PSI)score before treatment and 28 days after treatment,fatality rate and incidence of complications within 28 days after treatment.Results No statistically significant differences of heart rate,pH,PaO2,PaCO2 or SpO2 was found between the two groups before treatment or than those in control group,once sputum suction volume and 24-hour sputum suction volume in treatment group were statistically significantly more than those in control group,24-hour sputum suction times in treatment group was statistically significantly less than that in control group,and tracheotomy ratio in treatment group was statistically significantly lower than that in control group(P<0.05).No statistically significant differences of APACHEⅡscore or PSI score was found between the two groups before treatment(P>0.05),while APACHEⅡscore and PSI score in treatment group were statistically significantly lower than those in control group 28 days after treatment(P<0.05).No statistically significant differences of fatality rate was found between the two groups within 28 days after treatment(P>0.05),while incidence of ventilator-associated pneumonia(VAP)in treatment group was statistically significantly lower than that in control group(P<0.05).Conclusion NIPPV combined with self-made sputum suction device can effectively improve the sputum suction effect and prognosis in elderly severe pneumonia patients complicated with respiratory failure,reduce the pain and risk of VAP.