不同序贯通气转换标准对COPD合并呼吸衰竭患者肺氧合功能、外周血生物标志物及临床预后的影响

Impact of different sequential ventilation conversion criteria on lung oxygenation,peripheral blood biomarkers,and clinical outcomes in patients with chronic obstructive pulmonary disease complicated with respiratory failure

目的探讨不同序贯通气转换标准对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者肺氧合功能、外周血生物标志物及临床预后的影响。方法选取2022年1月至2023年5月南阳市第一人民医院呼吸危重症医学科收治的104例COPD合并呼吸衰竭患者作为研究对象,所有患者均行有创-无创序贯通气治疗,按照不同序贯通气转换标准分为三组,其中采用肺部感染控制窗(PICW)作为转换标准的34例患者作为PICW组,采用自主呼吸实验(SBT)作为转换标准的35例患者作为SBT组,采用SBT+PICW作为转换标准的35例患者作为综合组。比较三组患者的通气治疗时间、住ICU时间、总住院时间,以及治疗前、通气转换时、通气治疗结束时的病情改善情况、肺氧合功能指标[动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧合指数(OI)]和外周血生物标志物[C反应蛋白(CRP)、N末端B型脑利钠肽(NT-proBNP)、高迁移率族蛋白B1(HMGB1)、白细胞介素-27(IL-27)],同时比较三组患者的再插管率、并发症发生率及临床预后。结果综合组患者的有创通气时间、机械通气总时间、住ICU时间、总住院时间<SBT组<PICW组,差异均有统计学意义(P<0.05);综合组患者通气转换时、通气治疗结束时的格拉斯哥昏迷(GCS)评分>SBT组>PICW组,急性生理与慢性健康评价系统Ⅱ(APACHE)评分<SBT组<PICW组,差异均有统计学意义(P<0.05);综合组患者通气转换时、通气治疗结束时的PaCO_(2)<SBT组<PICW组,PaO_(2)、OI>SBT组>PICW组,差异均有统计学意义(P<0.05);综合组患者通气转换时、通气治疗结束时的外周血CRP、NT-proBNP、HMGB1、IL-27水平<SBT组<PICW组,差异均有统计学意义(P<0.05);综合组患者的再插管率、并发症发生率分别为2.86%、5.71%,明显低于SBT组(分别为22.86%、22.86%)和PICW组(分别为29.41%、32.35%),差异均有统计学意义(P<0.05),而SBT组与PICW组比较差异无统计学意义(P>0.05);综合组患者的临床预后优于SBT组、PICW组,差异有统计学意义(P<0.05)。结论COPD合并呼吸衰竭患者依据SBT+PICW确定有创-无创序贯通气转换时机,可缩短通气时间,纠正外周血生物标志物紊乱状态,其对患者病情程度、肺氧合功能、临床预后的改善效果更显著,并能降低再插管率和并发症发生率。

Objective To investigate the effects of different sequential ventilation conversion criteria on pulmonary oxygenation function,peripheral blood biomarkers,and clinical prognosis in patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods A total of 104 patients with COPD complicated with respiratory failure admitted to the Department of Respiratory Critical Care Medicine,Nanyang First People's Hospital from January 2022 to May 2023 were selected as the research subjects.All patients underwent invasive-noninvasive sequential ventilation therapy,and they were divided into three groups according to different sequential ventilation conversion criteria:PICW group[34 patients with pulmonary infection control window(PICW)as the conversion standard],SBT group[35 patients with spontaneous breathing test(SBT)as conversion criteria],and SBT+PICW group[35 patients with SBT+PICW as conversion criteria].The ventilation treatment time,ICU stay time,total length of hospital stay,as well as the improvement of disease condition,lung oxygenation function indicators[arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(OI)],peripheral blood biomarkers[C-reactive protein(CRP),N-terminal B-type brain natriuretic peptide(NT-proBNP),high mobility group protein B1(HMGB1),interleukin-27(IL-27)]before treatment,at the time of ventilation conversion,and at the end of ventilation treatment were compared among the three groups of patients.The reintubation rate,complication rate,and clinical prognosis were also compared between the two groups.Results The invasive ventilation time,total mechanical ventilation time,ICU stay time,and total length of hospital stay increased successively in SBT+PICW group,SBT group,and PICW group,with statistically significant differences(P<0.05).Glasgow Coma Scale(GCS)scores at the time of ventilation conversion and at the end of ventilation treatment decreased successively in SBT+PICW group,SBT group,PICW group(P<0.05),and Acute Physiological and Chronic Health Assessment SystemⅡ(APACHEⅡ)scores increased successively in the three groups(P<0.05).PaCO_(2)at the time of ventilation conversion and at the end of ventilation treatment increased successively in SBT+PICW group,SBT group,PICW group,while PaO_(2)and OI decreased successively,with statistically significant differences(P<0.05).Peripheral blood CRP,NT-proBNP,HMGB1,and IL-27 levels at the time of ventilation conversion and at the end of ventilation treatment increased successively in SBT+PICW group,SBT group,and PICW group(P<0.05).The reintubation rate and incidence of complications in SBT+PICW group were 2.86%and 5.71%,respectively,significantly lower than 22.86%and 22.86%in the SBT group and 29.41%and 32.35%in the PICW group(P<0.05),with statistically significant difference between the SBT group and the PICW group(P>0.05).The clinical prognosis of patients in SBT+PICW group was significantly better than that of the SBT group and PICW group(P<0.05).Conclusion The timing of invasive-noninvasive sequential ventilation conversion in patients with COPD and respiratory failure based on SBT+PICW can shorten the ventilation time,correct the disorder of peripheral blood biomarkers,and improve the patient's condition,pulmonary oxygenation function,and clinical prognosis.It can also reduce the reintubation rate and complication rate.