有创机械通气治疗时机对重症肺炎合并呼吸衰竭患者炎症因子及预后的影响

The effect of invasive mechanical ventilation treatment timing on inflammatory factors and prognosis in patients with severe pneumonia combined with respiratory failure

目的观察有创机械通气治疗时机对重症肺炎(SP)合并呼吸衰竭患者炎症因子及预后的影响。方法回顾性分析2021年1月—2023年1月在徐州医科大学附属医院接受机械通气治疗的94例SP合并呼吸衰竭患者的临床资料。按照有创机械通气治疗时机进行分组,早期组(n=54)有指征6 h内行有创机械通气治疗,延迟组(n=40)有指证6 h后行有创机械通气治疗。对比两组治疗效果及机械通气后48 h、72 h血气指标、炎症因子水平,以及预后情况。结果早期组总有效率明显高于延迟组(P<0.05);与治疗前比较,两组治疗后48、72 h,氧合指数(OI)明显升高,动脉血二氧化碳分压(PaCO_(2))明显降低(P<0.05);与延迟组比较,早期组OI明显升高,PaCO_(2)明显降低(P<0.05)。治疗前两组C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、降钙素原(PCT)水平无统计学差异(P>0.05);治疗后48、72 h两组均明显降低(P<0.05);与延迟组比较,治疗后48、72 h早期组CRP、TNF-α、IL-6、PCT水平更低(P<0.05)。早期组28 d内存活且ICU住院天数及需要机械通气天数更短,转出ICU后住院时间更少,28 d病死率更低(P<0.05)。结论出现机械通气指征6 h内行有创机械通气治疗SP合并呼吸衰竭具有更好的效果,有助于减轻机体炎症反应,改善患者的血气指标,改善患者预后。

Objective To observe the impact of invasive mechanical ventilation treatment timing on inflammatory factors and prognosis in patients with severe pneumonia(SP)complicated with respiratory failure.Methods A retrospective analysis was conducted on the clinical data of 94 patients with SP complicated with respiratory failure who underwent mechanical ventilation treatment in our hospital from January 2021 to January 2023.According to the timing of invasive mechanical ventilation treatment,the early group(n=54)received invasive mechanical ventilation treatment within 6 hours with indication,while the delayed group(n=40)received invasive mechanical ventilation treatment after 6 hours with indication.The early effects of the two groups,including blood gas indicators,inflammatory factor levels,and prognosis at 48 and 72 hours after mechanical ventilation were compared.Results The total effective rate of the early treatment group was significantly higher than that of the delayed group(P<0.05);Compared with before early,oxygenation index(OI)significantly increased and partial pressure of carbon dioxide in artery(PaCO_(2))significantly decreased in both groups 48 and 72 hours after treatment(P<0.05);Compared with the delayed group,the early group showed a significant increase in OI and a significant decrease in PaCO_(2)(P<0.05).There was no statistically significant difference in C-reactive protein(CRP),tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6)and procalcitonin(PCT)levels before treatment(P>0.05);After 48 and 72 hours of treatment,there was a significant decrease in both groups(P<0.05);Compared with the delayed group,the early treatment group showed CRP and TNF-αat 48 and 72 hours after treatment-α,the levels of IL-6 and PCT were lower(P<0.05).Compared with the delay group,the early group had fewer days of 28 day survival and ICU stay and days requiring mechanical ventilation,and shorter hospital stays after survival transfer out of the ICU.The 28 day mortality rate was lower than that of the delayed group(P<0.05).Conclusion Invasive mechanical ventilation within 6 hours after the appearance of mechanical ventilation indications has a better effect on treating SP with respiratory failure,which helps to reduce the body's inflammatory response,improve the patient's blood gas indicators,and improve the patient's prognosis.