重症肺炎患者机械通气期间气道分级管理的效果分析  

Effect analysis on airway management based on different grades in mechanically ventilated patients with severe pneumonia

作　　者：冯洁惠[1] 浦其斌[1] 高春华[1] 徐建宁[2] 

机构地区：[1]浙江大学医学院附属第一医院综合ICU,杭州310003 [2]浙江中医药大学护理学院,杭州310053

出　　处：《中华危重症医学杂志（电子版）》2011年第4期16-21,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

摘　　要：目的评价重症肺炎患者机械通气期间采用气道分级管理的干预效果。方法采用前瞻性队列研究,将76例重症肺炎患者随机分为研究组和对照组。对照组(36例)按常规每2h一次胸部物理治疗;研究组(40例)根据气道分级评分将气道管理级别分为A、B、C、D四级,实施不同频次的胸部物理治疗。比较两组患者机械通气期间潮气量(VT)、呼吸频率(f)、氧合指数(PaO2/FiO2)、急性病生理学和长期健康评价(APACHE)Ⅱ评分、机械通气时间及ICU住院时间。结果机械通气第7天,研究组患者VT、f、PaO2/FiO2均优于对照组(P均<0.001),APACHEⅡ评分低于对照组(P<0.05),研究组患者机械通气时间明显少于对照组(P<0.001)。结论基于不同频次胸部物理治疗的气道分级管理有助于减少重症肺炎患者机械通气期间物理治疗产生的副作用,改善其呼吸功能,缩短机械通气时间。Objective To evaluate the effect of airway management based on different grades in mechanical ventilated patients with severe pneumonia. Methods A prospective cohort controlled study was applied to the trail. A total of 76 severe pneumonia patients were randomly divided into two groups. The patients in control group （36 cases） received conventional chest physiotherapy every 2 hours. The patients in study group （40 cases） were taken into the chest physiotherapy program in different frequency according to airway grading assessment scores. The tidal volume （VT）, respiratory rate, oxygenation index （PaO2/FiO2 ratio）, patient＇s overall severity by acute physiology and chronic health evaluation （APACHE） Ⅱ score, duration of stay in intensive care unit （ICU）, duration of ventilator support, and complications were assessed and compared between the two groups. Results Compared with the control group, the VT, respiratory rate, PaO2/FiO2 ratio were better （all P〈0.001）, and APACHE Ⅱ score was lower on the 7th d after mechanical ventilation in the study group （P〈0.05）. In addition, the duration of ventilator support was shorter in the study group （P〈0.001）. Conclusion Airway management based on different grades could reduce the side effects of chest physiotherapy, improve the respiratory function and shorten the duration of ventilator support in patients with severe pneumonia .

关 键 词：气道管理 重症肺炎 机械通气 胸部物理治疗 

分 类 号：R563.1[医药卫生—呼吸系统]