通气序贯降级治疗对肺癌合并呼吸衰竭患者的疗效观察

Effect of Sequential Downgrade Ventilation on Lung Cancer Patients with Respiratory Failure

目的探讨通气序贯降级治疗对肺癌合并呼吸衰竭患者的疗效。方法选取80例肺癌合并呼吸衰竭气管切开患者,按照随机数字表法分为对照组(n=40)和观察组(n=40),出现肺部感染控制窗(PIC)后,对照组患者进行有创机械通气,观察组接受通气序贯降级治疗,观察记录两组患者治疗前后的生命体征和血气分析主要指标、机械通气时间、ICU入住时间、呼吸机相关肺炎(VAP)发生率和脱机成功率及治疗转归情况。结果治疗后两组患者心率、呼吸频率均降低,PaO_(2)均升高(P<0.05),但组间比较无明显差异(P>0.05),两组患者血压、pH值、PaCO_(2)治疗前后、组间比较均无明显差异(P>0.05)。与对照组相比,观察组机械通气时间和ICU入住时间缩短,呼吸机相关肺炎(VAP)发生率低,脱机成功率高(P<0.05)。观察组成功脱机31例;再次行有创通气5例。4例患者继续予以改装后的无创正压呼吸机,实施降级治疗。对照组成功脱机22例;继续行有创通气18例,其中1例患者在ICU死于感染。结论通气序贯降级治疗能改善肺癌合并呼吸衰竭患者气管切开患者血流动力学指标和氧合能力,减少机械通气时间和ICU入住时间,显著降低VAP发生率,提高呼吸机脱机成功率,有较高的临床应用价值。

Objective To explore the effect of sequential downgrade of ventilation on lung cancer patients with respiratory failure.Methods 80 lung cancer patients complicating respiratory failure were selected,and divided into 2 groups according to random number table methods,each with 40 cases.When pulmonary infection control window(PIC-Window)occurred,the control group received invasive mechanical ventilation,while the observation group received sequential invasive-noninvasive mechanical ventilation.Then comparison was conducted on the vital signs,blood gas analysis index,mechanical ventilation time,ICU stay time,the incidence of ventilator-associated pneumonia(VAP),success rate of weaning from mechanical ventilation and the treatment outcomes.Results After treatment,a decrease in heart rate and respiratory rate,and an increase in PaO_(2) were detected in both groups(P<0.05),while the 3 indicators yielded no statistical difference between groups(P>0.05).The pre-and post-treatment blood pressure,pH value and PaCO_(2) demonstrated no statistical difference between the 2 groups(P>0.05).Compared with the control group,the observation group had decreased time to mechanical ventilation and ICU stay length,lower VAP rate,and higher success rate of weaning from mechanical ventilation,with statistical difference(P<0.05).Among 40 patients in the observation group,31 patients were successfully weaned from mechanical ventilation,5 patients switched to invasive ventilation again,and the remaining 4 patients still applied non-invasive positive pressure ventilation and transferred to the general ward.In the control group,22 patients were successfully weaned from mechanical ventilation,18 patients still applied non-invasive ventilation,and 1 died in ICU due to the infection.Conclusion Application of sequential invasive-noninvasive mechanical ventilation in the treatment of respiratory failure in lung cancer patients can effectively ameliorate the hemodynamic indexes and oxygenation capacity,shorten the mechanical ventilation time and ICU stay length,reduce the VAP rate,and improve the success rate of weaning from mechanical ventilation,which is of great clinical value.