气道分级管理下差异化胸部物理干预对老年重症肺炎机械通气患者呼吸功能、呼吸机相关性肺炎的影响

Effect of differentiated chest physical intervention under graded airway management on respiratory function and ventilator-associated pneumonia in elderly patients with severe pneumonia on mechanical ventilation

目的:研究对老年重症肺炎机械通气患者采用基于气道分级管理的差异化胸部物理干预对其呼吸功能及血气指标的影响。方法:选取本院我科2018年1月—2021年12月期间70例老年重症肺炎机械通气患者随机分组,对照组35例给予常规胸部物理干预,观察组35例给予基于气道分级管理予以差异化胸部物理干预,对比两组患者血气指标、呼吸功能、呼吸机相关性肺炎、下肢静脉血栓、肺不张等并发症发生情况。结果:观察组干预后动脉血氧分压(PO)、氧合指数/吸入氧浓度(PO/FiO)、潮气量(VT)均高于对照组,二氧化碳分压(PCO)、呼吸频率(RR)、吸气阻力(Ri)、呼吸肌相关性肺炎发生率低于对照组(P<0.05);观察组下肢静脉血栓、肺不张发生率与对照组接近(P>0.05)。结论:基于气道分级管理的差异化胸部物理干预对老年重症肺炎机械通气患者效果确切,能够有效提高患者呼吸功能,改善血气指标,降低呼吸肌相关性肺炎发生率。

Objective: To study the effects of differentiated chest physical intervention based on graded airway management on respiratory function and blood gas indexes in elderly patients with severe pneumonia on mechanical ventilation. Methods: A total of 70 elderly patients with severe pneumonia on mechanical ventilation in our department from january 2018 to December 2021 were randomly divided into the control group(35 cases) and the observation group(35 cases). The control group received routine chest physical intervention, while the observation group received differentiated chest physical intervention based on graded airway management. Blood gas index, respiratory function,ventilator-associated pneumonia, lower extremity venous thrombosis, atelectasis and other complications were compared between the two groups. Results: After intervention, the partial pressure of oxygen(PO), oxygenation index/inhaled oxygen concentration(PO/FiO) and tidal volume(VT) in the observation group were higher than those in the control group, and the partial pressure of carbon dioxide(PCO), respiratory rate(RR), inspiratory resistance(Ri) and the incidence of respiratory muscle associated pneumonia in the observation group were lower than those in the control group(P<0.05). The incidence of lower extremity venous thrombosis and atelectasis in the observation group were close to those in the control group(P>0.05). Conclusion: Differentiated chest physical intervention based on graded airway management has a definite effect on mechanically ventilated elderly patients with severe pneumonia, which can effectively improve the respiratory function of patients, improve blood gas indexes, and reduce the incidence of respiratory muscle-associated pneumonia.