序贯机械通气治疗在重症肺炎并呼吸衰竭患者中应用

Application of Sequential Mechanical Ventilation in Patients with Severe Pneumonia Complicated with Respiratory Failure

目的:分析重症肺炎并呼吸衰竭应用序贯机械通气治疗的临床效果。方法:按照随机数表法将2021年3月—2022年5月北京市石景山医院收诊的84例重症肺炎并呼吸衰竭患者分为两组,各42例。对照组开展有创机械通气治疗,观察组采用有创-无创序贯机械通气治疗,对比两组通气质量、肺功能指标、血气指标、炎症因子变化情况等。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,呼吸机相关肺炎(VAP)发生率低于对照组(P<0.05)。治疗后,两组肺功能指标、血气指标、炎症因子水平均优于治疗前,且观察组第1秒用力呼气容积(FEV_(1))、FEV_(1)占预计值百分比(FEV_(1)%pred)、第1秒用力呼气容积占用力肺活量百分比(FEV_(1)/FVC%)、动脉氧分压(PaO_(2))均高于对照组(P<0.05),动脉二氧化碳分压(PaCO_(2))、白细胞介素-10(IL-10)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均低于对照组(P<0.05)。结论:重症肺炎并呼吸衰竭应用有创-无创序贯机械通气治疗可明显提高患者通气质量,缩短有创通气时间,提高呼吸功能,促进其血气指标恢复正常,同时降低炎症因子刺激作用,对患者有着至关重要的意义。

Objective:To analyze the clinical effect of sequential mechanical ventilation in the treatment of severe pneumonia complicated with respiratory failure.Method:A total of 84 patients with severe pneumonia complicated with respiratory failure who treated in Beijing Shijingshan Hospital from March 2021 to May 2022 were divided into two groups by random number table method,42 cases in each group.The control group was treated with invasive mechanical ventilation,and the observation group was treated with invasive-non-invasive sequential mechanical ventilation.The changes in ventilation quality,pulmonary function indexes,blood gas indexes,and inflammatory factors were compared between two groups.Result:The invasive ventilation time,oxygen use time and ICU stay time in the observation group were shorter than those 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,the lung function indexes,blood gas indexes and inflammatory factor levels of two groups were better than those before treatment,and forced expiratory volume in one second(FEV_(1)),the percentage of FEV_(1) to the predicted value(FEV_(1)%pred),percentage of forced expiratory volume in one second to forced vital capacity(FEV_(1)/FVC%),and the arterial partial pressure of oxygen(PaO_(2))in the observation group were higher than those in the control group(P<0.05),and the arterial partial pressure of carbon dioxide(PaCO_(2)),interleukin-10(IL-10),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)were lower than those in the control group(P<0.05).Conclusion:The application of invasive-non-invasive sequential mechanical ventilation in severe pneumonia complicated with respiratory failure can greatly improve the ventilation quality of patients,shorten the time of invasive ventilation,improve respiratory function,promote the return of blood gas indexes to normal,and reduce the stimulation of inflammatory factors,it is of vital significance to patients.