序贯通气转换标准差异对重症肺炎伴呼吸衰竭病人病程及临床预后的影响

Influence of sequential ventilation conversion standard difference on the disease course and clinical prognosis of patients with severe pneumonia combined with respiratory failure

目的探讨序贯通气转换标准差异对重症肺炎伴呼吸衰竭病人病程及临床预后的影响。方法选取武汉市第五医院2016年1月至2018年1月收治重症肺炎伴呼吸衰竭病人共100例,以随机数字表法分为控制窗组(50例)和呼吸试验组(50例),分别根据肺部感染控制窗(PICW)和自主呼吸试验(SBT)确定序贯通气转换时机;比较两组病人通气用时、重症监护病房(ICU)住院用时、住院总用时、再插管率、呼吸机相关性肺炎(VAP)发生率及院内死亡率。结果呼吸试验组病人有创通气用时、机械通气总用时、ICU住院用时及住院总用时分别为(7.65±1.48)d,(10.10±2.10)d,(14.22±2.05)d,(20.74±3.51)d,均显著短于控制窗组的(12.93±2.04)d,(16.33±3.17)d,(22.14±3.60)d,(29.47±4.64)d,P<0.05;呼吸试验组病人再插管率和VAP发生率分别为14.00%,8.00%,显著低于控制窗组的38.00%,24.00%(P<0.05);同时两组病人院内死亡率比较差异无统计学意义(P>0.05)。结论针对重症肺炎伴呼吸衰竭病人根据SBT确定序贯通气转换时机可有效缩短通气时间,加快病情康复进程,预防再插管和VAP发生,价值优于PICW。

Objective To investigate the influence of sequential ventilation conversion standard difference on the disease course and clinical prognosis of patients with severe pneumonia combined with respiratory failure.Methods100 patients with severepneumonia combined with respiratory failure admitted to the Fifth Hospital of Wuhan from January 2016 to January 2018 were di-vided into a control window group(50 cases)and a respiratory test group(50 cases)by random number table method.Determinethe timing of sequential ventilation conversion according to the Pulmonary Infection Control Window(PICW)and SpontaneousBreathing Test(SBT);and the ventilation time,ICU hospitalization time,total hospitalization time,re-intubation rate,VAP rate andhospital mortality of both groups were compared.ResultsThe invasive ventilation time,total mechanical ventilation time,ICU hos-pitalization time and total hospitalization time of breathing test group were(7.65±1.48)d,(10.10±2.10)d,(14.22±2.05)d,(20.74±3.51)d,which were significantly shorter than control window group which respectively were(12.93±2.04)d,(16.33±3.17)d,(22.14±3.60)d,(29.47±4.64)d(P<0.05).The re-intubation rate and VAP rate of B group for 14.00%and 8.00%were significantly lowerthan control window group for 38.00%and 24.00%(P<0.05).There was no statistically significant difference in the hospital mortali-ty between 2 groups(P>0.05).ConclusionCompared with PICW,SBT for sequential ventilation conversion standard on patientswith severe pneumonia combined with respiratory failure can efficiently shorten the invasive ventilation time and total mechanicalventilation time,accelerate the recovery process and be helpful to reduce the risk of re-intubation and VAP,and is better than PICW.