不同呼吸机模式在重症肌无力危象中的应用效果分析

Analysis of the Application Effect of Different Ventilator Modes in Myasthenia Gravis Crisis

目的分析不同呼吸机模式在重症肌无力危象中的应用效果。方法研究时段自2015年11月—2018年11月,方便选取该院收治的重症肌无力危象患者20例,以随机化原则分组,分试验组(10例,同步间歇指令通气与压力支持通气联合)、对照组(10例,压力控制通气模式),比较临床疗效、各指标变化情况、上机时间、ICU(重症监护室)留置时间、并发症。结果①试验组临床总有效率(100.00%)显著较对照组(60.00%)高(χ^2=5.000,P=0.025)。②试验组治疗后1 h二氧化碳分压、氧分压、呼吸频率、心率分别是(50.62±2.05)mmHg、(60.25±3.25)mmHg、(13.52±2.05)次/min、(92.62±6.28)次/min;试验组治疗后24 h二氧化碳分压、氧分压、呼吸频率、心率分别是(40.08±1.26)mmHg、(83.26±9.26)mmHg、(10.05±1.25)次/min、(78.25±4.16)次/min;对照组治疗后1 h二氧化碳分压、氧分压、呼吸频率、心率分别是(54.26±2.05)mmHg、(63.24±3.06)mmHg、(16.51±2.04)次/min、(103.58±6.11)次/min;试验组治疗后24 h二氧化碳分压、氧分压、呼吸频率、心率分别是(44.26±1.62)mmHg、(86.25±8.05)mmHg、(13.25±1.31)次/min、(84.62±7.04)次/min。试验组治疗后1 h显著较对照组低(t=3.970、2.118、3.270、3.956,P=0.001、0.048、0.004、0.001);试验组治疗后24 h显著较对照组低(t=6.441、2.317、5.589、2.464,P=0.000、0.033、0.000、0.024)。①试验组上机时间、ICU留置时间分别是(10.02±0.68)d、(18.26±3.05)d;对照组分别是(11.38±1.04)d、(26.66±5.07)d,试验组显著较对照组短(t=3.461、4.490 P=0.003、0.000)。④试验组并发症发生率(10.00%)显著较对照组(60.00%)低(χ^2=5.495,P=0.019)。结论同步间歇指令通气与压力支持通气联合对重症肌无力危象患者生命体征影响不大,且明显缩短了患者ICU留置时间,降低并发症发生率,安全有效,值得借鉴。

Objective To analyze the application effect of different ventilator modes in myasthenia gravis crisis.Methods From November 2015 to November 2018,20 patients with myasthenia gravis crisis in our hospital were convenient selected and grouped by randomization.The test group(10 cases,synchronized intermittent mandatory ventilation and pressure support ventilation combined),the control group(10 cases,pressure control ventilation mode),compare clinical efficacy,changes in various indicators,time of the machine,ICU(intensive care unit)indwelling time,complications.Results 1.The total clinical effective rate(100.00%)of the experimental group was significantly higher than that of the control group(60.00%)(χ^2=5.000,P=0.025).2.1 h after treatment,the partial pressure of carbon dioxide,oxygen partial pressure,respiratory rate and heart rate were(50.62±2.05)mmHg,(60.25±3.25)mmHg,(13.52±2.05)times/min,(92.62±6.28)times/min;the partial pressure of carbon dioxide,oxygen partial pressure,respiratory rate,and heart rate at 24 h after treatment were(40.08±1.26)mmHg,(83.26±9.26)mmHg,(10.05±1.25)times/min,(78.25±4.16)times/min;the control group 1 h after CO2 partial pressure,oxygen partial pressure,respiratory rate,and heart rate were(54.26±2.05)mmHg,(63.24±3.06)mmHg,(16.51±2.04)times/min,(103.58±6.11)times/min;the carbon dioxide partial pressure,oxygen partial pressure,respiratory rate and heart rate of the test group 24 h after treatment were(44.26±1.62)mmHg,(86.25±8.05)mmHg,(13.25±1.31)times/min,(84.62±7.04)times/min.The test group was significantly lower than the control group at 1 h(t=3.970,2.118,3.270,3.956,P=0.001,0.048,0.004,0.001);the test group was significantly lower than the control group at 24 h after treatment(t=6.441,2.317,5.589,2.463,P=0.000,0.033,0.000,0.024).3.The test time and ICU indwelling time of the test group were(10.02±0.68)d and(18.26±3.05)d,respectively;the control group were(11.38±1.04)d and(26.66±5.07)d,respectively.The control group was short(t=3.461,4.490,P=0.003,0.000).4.The incidence of complications in the experimental group(10.00%)was significantly lower than that in the control group(60.00%)(χ^2=5.495,P=0.019).Conclusion Synchronous intermittent mandatory ventilation combined with pressure support ventilation has little effect on the vital signs of patients with myasthenia gravis crisis,and significantly shortens the ICU indwelling time and reduces the incidence of complications.It is safe and effective and worth learning.