气管切开呼吸机依赖患者经有创-无创机械通气降级治疗的临床效果

Clinical effect of invasive-noninvasive mechanical ventilation step-down therapy on patients with dysfunctional ventilatory weaning response

目的 研究气管切开呼吸机依赖(DVWR)患者经有创-无创机械通气降级治疗的临床价值。方法 95例DVWR患者,将其按照电脑随机数字表法分作观察组(47例)和对照组(48例)。对照组开展持续机械通气治疗,观察组则开展有创-无创机械通气降级治疗。对比两组患者治疗前后各项生命体征(收缩压、舒张压、心率、呼吸频率)、血气指标[动脉血氧分压(Pa O_(2))、动脉二氧化碳分压(Pa CO_(2))、p H值、剩余碱(BE)]、生活质量以及撤机成功率、重症加强护理病房(ICU)住院时长、住院死亡率。结果 治疗前,观察组患者收缩压为(122.42±7.94)mm Hg(1 mm Hg=0.133 k Pa)、舒张压为(70.42±3.45)mm Hg、心率为(87.11±4.21)次/min、呼吸频率为(20.17±3.02)次/min,对照组患者收缩压为(122.37±7.82)mm Hg、舒张压为(70.37±3.51)mm Hg、心率为(87.20±4.18)次/min、呼吸频率为(20.20±3.04)次/min;治疗24 h后,观察组患者收缩压为(121.76±8.01)mm Hg、舒张压为(70.48±3.26)mm Hg、心率为(88.60±4.55)次/min、呼吸频率为(21.33±3.16)次/min,对照组患者收缩压为(122.05±7.96)mm Hg、舒张压为(70.50±3.31)mm Hg、心率为(88.59±4.79)次/min、呼吸频率为(20.78±3.12)次/min。治疗前后两组患者收缩压、舒张压、心率、呼吸频率对比,差异均不明显(P>0.05)。治疗前,观察组患者Pa O_(2)为(95.22±10.30)mm Hg、Pa CO_(2)为(40.38±3.19)mm Hg、p H值为(7.51±0.12)、BE为(5.10±0.14)mmol/L,对照组患者Pa O_(2)为(95.05±10.27)mm Hg、Pa CO_(2)为(40.45±3.21)mm Hg、p H值为(7.51±0.13)、BE为(5.12±0.13)mmol/L;治疗24 h后,观察组患者Pa O_(2)为(92.48±8.37)mm Hg、Pa CO_(2)为(40.19±3.21)mm Hg、p H值为(7.53±0.13)、BE为(5.20±0.12)mmol/L,对照组患者Pa O_(2)为(93.11±8.42)mm Hg、Pa CO_(2)为(40.34±3.20)mm Hg、p H值为(7.52±0.14)、BE为(5.17±0.13)mmol/L。治疗前后,两组患者患者Pa O_(2)、Pa CO_(2)、p H值、BE对比,差异均不明显(P>0.05)。观察组撤机成功率48.94%高于对照组的29.17%,ICU住院时长(15.23±3.84)d短于对照组的(20.51±4.91)d,差异明显(P<0.05)。观察组和对照组治疗前的生活质量评分分别为(35.12±3.48)、(34.78±3.50)分,治疗24周后分别为(76.10±6.23)、(69.38±4.17)分。治疗24周后,两组患者生活质量评分均高于治疗前,且观察组高于对照组,差异明显(P<0.05)。结论 有创-无创机械通气降级治疗策略应用于气管切开DVWR患者中的效果较佳,可提高撤机成功率,缩短患者ICU住院时长,有利于改善患者生活质量。

Objective To study the clinical value of invasive-noninvasive mechanical ventilation step-down therapy on patients with dysfunctional ventilatory weaning response(DVWR).Methods 95 patients with DVWR were divided into an observation group(47 cases)and a control group(48 cases)according to computer random number table method.The control group was treated with continuous mechanical ventilation,and the observation group was treated with invasive and non-invasive mechanical ventilation step-down therapy.Patients in both groups were compared in terms of vital signs(systolic blood pressure,diastolic blood pressure,heart rate,respiratory rate),blood gas indicators[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),pH,base excess(BE)]and quality of life before and after treatment,success rate of ventilator weaning,length of intensive care unit(ICU)stay,and in-hospital mortality.Results Before treatment,the systolic blood pressure,diastolic blood pressure,heart rate and respiratory rate of the observation group were(122.42±7.94)mm Hg,(70.42±3.45)mm Hg(1 mm Hg=0.133 kPa),(87.11±4.21)beats/min and(20.17±3.02)times/min,the control group were(122.37±7.82)mm Hg,(70.37±3.51)mm Hg,(87.20±4.18)beats/min and(20.20±3.04)times/min.After 24 h of treatment,the systolic blood pressure,diastolic blood pressure,heart rate and respiratory rate of the observation group were(121.76±8.01)mm Hg,(70.48±3.26)mm Hg,(88.60±4.55)beats/min and(21.33±3.16)times/min,while those of the control group were(122.05±7.96)mm Hg,(70.50±3.31)mm Hg,(88.59±4.79)beats/min and(20.78±3.12)times/min.There were no significant differences in systolic blood pressure,diastolic blood pressure,heart rate and respiratory rate between two groups before and after treatment(P>0.05).Before treatment,PaO_(2),PaCO_(2),pH and BE of the observation group were(95.22±10.30)mm Hg,(40.38±3.19)mm Hg,(7.51±0.12)and(5.10±0.14)mmol/L,while those of the control group were(95.05±10.27)mm Hg,(40.45±3.21)mm Hg,(7.51±0.13)and(5.12±0.13)mmol/L.After 24 h of treatment,PaO_(2),PaCO_(2),pH and BE of the observation group were(92.48±8.37)mm Hg,(40.19±3.21)mm Hg,(7.53±0.13)and(5.20±0.12)mmol/L,while those of the control group were(93.11±8.42)mm Hg,(40.34±3.20)mm Hg,(7.52±0.14)and(5.17±0.13)mmol/L.There were no significant differences in PaO_(2),PaCO_(2),pH and BE between the two groups before and after treatment(P>0.05).The success rate of ventilation weaning of 48.94%in the observation group was higher than 29.17%in the control group,and the length of ICU stay of(15.23±3.84)d was shorter than(20.51±4.91)d in the control group.The difference was significant(P<0.05).The quality of life scores of the observation group and the control group were(35.12±3.48)and(34.78±3.50)points before treatment,and(76.10±6.23)and(69.38±4.17)points after 24 weeks of treatment.After 24 weeks of treatment,the quality of life score in both group were higher than that before treatment,and the observation group was higher than the control group.The difference was significant(P<0.05).Conclusion The application of invasive-noninvasive mechanical ventilation step-down therapy in patients with DVWR is more effective,which can improve the success rate of ventilatory weaning,shorten the length of ICU stay of patients,and is conducive to the improvement of patients'quality of life.