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

Clinical Efficacy of Invasive-noninvAsive sequential Mechanical Ventilation in the treatment of Traumatic ARDS and its Effect on Serum NT-proBNP and Inflammatory Factors

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.