有创-无创序贯机械通气治疗重症肺炎并呼吸衰竭患者的临床效果及预后情况

Clinical effect and prognosis of invasive-noninvasive sequential mechanical ventilation in the treatment of patients with severe pneumonia and respiratory failure

目的探讨有创-无创序贯机械通气治疗重症肺炎(SP)并呼吸衰竭患者的临床效果及预后情况。方法将2017年5月至2019年5月我院收治的150例SP并呼吸衰竭患者按治疗方式分为对照组(75例,有创机械通气)和观察组(75例,有创-无创序贯机械通气)。比较两组的通气质量、血气指标、炎症指标、心肌损伤指标及预后情况。结果观察组有创通气时间、用氧时间、ICU住院时间均短于对照组,脱机成功率高于对照组,呼吸机相关性肺炎(VAP)发生率低于对照组(P<0.05)。治疗后,观察组的PaCO2低于对照组,PaO2、HCO3-高于对照组(P<0.05)。治疗后,观察组的IL-6、IL-10、TNF-α、NT-proBNP、cTnI、CK-MB水平均低于对照组(P<0.05)。治疗后,观察组的APACHEⅡ、PSI评分均低于对照组(P<0.05)。结论有创-无创序贯机械通气治疗SP并呼吸衰竭的临床效果显著,可提高通气质量,改善血气指标,减轻炎症反应及心肌损伤,有利于患者预后。

Objective To explore the clinical effect and prognosis of invasive-noninvasive sequential mechanical ventilation in the treatment of patients with severe pneumonia(SP)and respiratory failure.Methods A total of 150 patients with SP and respiratory failure admitted in our hospital from May 2017 to May 2019 were divided into control group(75 cases,invasive mechanical ventilation)and observation group(75 cases,invasive-noninvasive sequential mechanical ventilation)according to the treatment methods.The ventilation quality,blood gas index,inflammation index,myocardial injury index and prognosis of the two groups were compared.Results The invasive ventilation time,oxygen consumption time and ICU hospitalization time in the observation group were shorter than those in the control group,the success rate of weaning was higher than that in the control group,and the incidence of ventilator-associated pneumonia(VAP)was lower than that in the control group(P<0.05).After treatment,PaCO2 in the observation group was lower than that in the control group,while PaO2 and HCO3-in the observation group were higher than those in the control group(P<0.05).After treatment,the levels of IL-6,IL-10,TNF-α,NT-proBNP,cTnI and CK-MB in the observation group were lower than those in the control group(P<0.05).After treatment,the APACHEⅡand PSI scores in the observation group were lower than those in the control group(P<0.05).Conclusion Invasive-noninvasive sequential mechanical ventilation has a significant clinical effect in the treatment of SP and respiratory failure,which can improve the quality of ventilation and blood gas index,reduce inflammation and myocardial damage,and benefit the prognosis of patients.