呼吸支持阶梯化管理在老年急危重症患者院前转运救治中的应用价值

Application value of stepwise management of respiratory support in pre-hospital transportation and treatment of elderly patients with acute and critical illness

目的探讨呼吸支持阶梯化管理在老年急危重症患者院前转运救治中的应用价值,为治疗该类型病症提供方法。方法选取2020年8月—2022年8月实施院前转运救治的老年急危重症患者86例,采取数字表法随机分为观察组和对照组,每组43例。对照组接受常规呼吸支持治疗,观察组给予呼吸支持阶梯化管理治疗。观察并比较2组呼吸支持方式、复苏情况、慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、治疗前后生命体征指标[心率(HR)、舒张压(DBP)、收缩压(SBP)]值和气道并发症情况。结果2组选择呼吸支持方式最常见是气管插管,其次是复苏体位,其中观察组复苏体位方式选择率显著高于对照组(P<0.05),气管切开选择率显著低于对照组(P<0.05);观察组复苏成功率显著高于对照组(P<0.05),平均复苏时间及呼吸平稳时间显著少于对照组(P<0.05),APACHEⅡ评分显著低于对照组(P<0.05)。治疗后,2组HR、MAP、PaCO_(2)较治疗前显著性降低(P<0.05),观察组显著低于对照组(P<0.05),2组PaO_(2)较治疗前显著性升高(P<0.05),观察组显著高于对照组(P<0.05);观察组VAP发生率和气道并发症总发生率显著低于对照组(P<0.05)。结论呼吸支持阶梯化管理应用于老年急危重症患者院前转运救治,可降低气管切开选择率,改善患者预后结局,具有一定的应用价值。

Objective To explore the application value of stepwise management of respiratory support in the pre-hospital transportation and treatment of elderly patients with acute and critical illness,and provide treatment for this type of disorder.Methods 86 elderly patients with acute and critical illness who received pre-hospital transportation and treatment from August 2020 to August 2022 were selected as the study subjects,and divided into control group and observation group by means of the random number table method,with 43 cases in each group.The control group received conventional respiratory support treatment,while the observation group received stepwise management of respiratory support treatment.The respiratory support mode,resuscitation status,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,vital sign indicators[heart rate(HR),diastolic blood pressure(DBP),systolic blood pressure(SBP)before and after treatment]and airway complications were observed and compared between the two groups.Results Tracheal intubation was the most common choice of respiratory support in both groups,followed by resuscitation position.The selection rate of resuscitation position in the observation group was significantly higher than that in the control group(P<0.05),while the selection rate of tracheotomy was significantly lower than that in the control group(P<0.05).The success rate of resuscitation in the observation group was significantly higher than that in the control group(P<0.05),and the average resuscitation time and stable breathing time were significantly shorter than those in the control group(P<0.05),and the APACHEⅡscore was significantly lower than that in the control group(P<0.05).After treatment,the HR,MAP and PaCO_(2) of both groups were significantly lower than those of the same group before treatment(P<0.05),and the above three indicators of the observation group were significantly lower than those of the control group(P<0.05);the PaO_(2) of both groups was significantly higher than that of the same group before treatment(P<0.05),and the PaO2 of the observation group was significantly higher than that of the control group(P<0.05).The incidences of VAP and total airway complications in the observation group were significantly lower than those in the control group(P<0.05).Conclusion The application of stepwise management of respiratory support in the pre-hospital transportation and treatment of elderly patients with acute and critical illness can reduce the selection rate of tracheotomy,and improve the prognosis of patients,which has certain application value.