序贯机械通气在重症肺炎合并呼吸衰竭中的应用及对患者血流动力学的影响

The application of sequential mechanical ventilation in severe pneumonia combined with respiratory failure and its impact on patient hemodynamics

目的探讨序贯机械通气在重症肺炎合并呼吸衰竭中的应用及对患者血流动力学的影响。方法选取2019年1月至2022年3月中国人民解放军联勤保障部队第967医院收治的78例重症肺炎合并呼吸衰竭患者作为研究对象,根据治疗方法不同分为对照组与研究组,每组39例。对照组行常规有创机械通气,研究组行序贯机械通气,比较两组机械通气治疗相关指标、住院时间、血气指标、炎症因子水平、心肌损伤指标、血流动力学指标及并发症发生情况。结果研究组有创通气时间、机械通气总时间及住院时间均短于对照组,差异有统计学意义(P<0.05);治疗后,两组动脉血氧分压(PaO2)、碳酸氢根(HCO3-)水平均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组氨基末端脑钠尿肽(NT-proBNP)水平及研究组肌钙蛋白I(cTnI)水平均低于治疗前,对照组cTnI水平高于治疗前,且研究组cTnI、NT-proBNP水平均低于对照组,差异有统计学意义(P<0.05)。治疗后,两组心率(HR)、呼吸频率(RR)均慢于治疗前,收缩压(SBP)均低于治疗前,且研究组HR、RR均慢于对照组,SBP低于对照组,差异有统计学意义(P<0.05)。研究组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论序贯机械通气治疗重症肺炎合并呼吸衰竭疗效显著,可缩短住院时间,有效改善患者炎症反应、心肌损伤指标及血流动力学指标,且安全性较高。

Objective To explore the application of sequential mechanical ventilation in severe pneumonia combined with respiratory failure and its impact on patient hemodynamics.Methods 78 patients with severe pneumonia combined with respiratory failure admitted to the 967th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China from January 2019 to March 2022 were selected as the study subjects,and they were divided into the control group and the study group based on different treatment methods,with 39 cases in each group.The control group received routine invasive mechanical ventilation,while the study group received sequential mechanical ventilation.The treatment re-lated indicators,hospitalization time,blood gas indicators,inflammatory factor levels,myocardial injury indicators,hemodynamic indicators,and in-cidence of complications were compared between the two groups.Results The invasive ventilation time,total mechanical ventilation time,and hospitalization time in the study group were shorter than those in the control group,and the differences were statistically significant(P<0.05).Af-ter treatment,the levels of partial pressure of oxygen(PaO2)and carbonic acid hydrogen radical(HCO3−)of the two groups were higher than before treatment,and the study group was higher than the control group,and the differences were statistically significant(P<0.05).After treatment,the levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and C-reactive protein(CRP)of the two groups were lower than before treatment,and the study group was lower than the control group,and the differences were statistically significant(P<0.05).After treatment,the levels of N terminal brain natriuretic peptide(NT-proBNP)of the two groups and cardiac troponin I(cTnI)in the study group were lower than before treatment,while the levels of cTnI in the control group were higher than before treatment,and the levels of cTnI and NT-proBNP in the study group were low-er than those in the control group,and the differences were statistically significant(P<0.05).After treatment,the heart rate(HR)and respiratory rate(RR)of the two groups were slower than those before treatment,and the systolic blood pressure(SBP)was lower than that before treatment,and the HR and RR in the study group were slower than those in the control group,and the SBP was lower than that in the control group,the differ-ences were statistically significant(P<0.05).The incidence of complications in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Sequential mechanical ventilation has significant therapeutic effect on severe pneu-monia combined with respiratory failure,which can shorten hospitalization time,effectively improve inflammation response,myocardial injury indi-cators,and hemodynamic indicators in patients,and has high safety.