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有创-无创序贯机械通气治疗创伤性ARDS的临床疗效及对患者血清中NT-proBNP和炎症因子水平的影响 被引量:13

Clinical Efficacy of Invasive-noninvAsive sequential Mechanical Ventilation in the treatment of Traumatic ARDS and its Effect on Serum NT-proBNP and Inflammatory Factors
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摘要 目的:观察有创-无创序贯机械通气治疗创伤性急性呼吸窘迫综合征(ARDS)的临床疗效及对患者血清N末端B型脑钠肽前体(NT-proBNP)和炎症因子水平的影响.方法:以我院2016年10月至2018年10月收治的96例创伤性ARDS患者为研究对象,均需机械通气,随机分为两组,各48例,A组选择有创-无创序贯机械通气方式,B组选择单纯有创机械通气方式,比较两组治疗前与治疗24h后血气分析指标、治疗前与治疗3d后血清NT-proBNP、炎症因子[白介素6(IL-6)、肿瘤坏死因子α(TNF-α)]水平,并观察两组机械通气指标、脱机后情况.结果:治疗24h后,两组血pH、PaCO2与PaO2均较治疗前得到明显改善(P<0.05),两组血pH、PaCO2与PaO2治疗前及治疗前后差值比较无明显差异(P>0.05);A组血清NT-proBNP、IL-6、TNF-α水平治疗前后差值明显高于B组(P<0.05);A组总通气时间与有创通气时间、住ICU时间均明显短于B组,且VAP发生率明显低于B组(P<0.05).结论:有创-无创序贯机械通气治疗ARDS,可有效改善患者血气指标,减轻心损伤与机体炎症,降低VAP发生率,缩短康复进程. Objective: To observe the clinical curative effect of invasive-noninvasive sequential mechanical ventilation on traumatic acute respiratory distress syndrome (ARDS) and the influences levels of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) and inflammatory factors in serum. Methods: 96 patients with traumatic ARDS who were admitted to the hospital and needed mechanical ventilation from October 2016 to October 2018 were randomly divided into 2 groups, 48 cases in each group. Group A was given invasive-noninvasive sequential mechanical ventilation, while group B was given simple invasive mechanical ventilation. The blood gas analysis indexes before and at 24h after treatment, levels of serum NT-proBNP and inflammatory factors [interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α)] before and at 3d after treatment were compared between the 2 groups. The indexes of mechanical ventilation and conditions after weaning in the 2 groups were observed. Results: The blood pH, PaCO 2 and PaO 2 in the 2 groups were significantly improved at 24h after treatment (P<0.05), There was no significant difference in the above indexes between the two groups before and after treatment (P>0.05). The difference values of serum NT-proBNP, IL-6 and TNF-α levels before and after treatment in group A were significantly higher than those in group B (P<0.05). The total ventilation time, invasive ventilation time and length of stay in ICU of group A were significantly shorter than those of group B, and the incidence of VAP was significantly lower than that in group B (P<0.05). Conclusion: The invasive-noninvasive sequential mechanical ventilation can effectively improve blood gas indexes, relieve heart injury and inflammation, decreased incidence of VAP and shorten the rehabilitation process of patients with traumatic ARDS.
作者 王新凤 杨爱珍 丁兆勇 王清峰 WANG Xinfeng;YANG Aizhen;DING Zhaoyong(Eighth People's Hospital of Qingdao, Shandong Qingdao 266001, China)
出处 《河北医学》 CAS 2019年第8期1291-1294,共4页 Hebei Medicine
基金 山东省2017年度医药科研指导计划,(编号:2017-WJZD087)
关键词 有创-无创 序贯机械通气 创伤性 急性呼吸窘迫综合征 炎症因子 Invasive-noninvasive Sequential mechanical ventilation Traumatic Acute respiratory distress syndrome Inflammatory factors
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