肺损伤预测评分指导下有创机械通气在慢性阻塞性肺疾病急性加重患者中的应用  

Application of invasive mechanical ventilation under the guidance of lung injury prediction score in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：朱良峰[1] 陈万[1] 吕立文[1] 唐宇涛[1] 曾希[1] 石磊[1] ZHU Lang-feng;CHEN Wan;LV Li-wen;TANG Yu-tao;ZENG Xi;SHI Lei(Department of Emergency,the People＇s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,Guangxi,CHINA)

机构地区：[1]广西壮族自治区人民医院急诊科,广西南宁530021

出　　处：《海南医学》2018年第15期2094-2096,共3页Hainan Medical Journal

基　　金：广西卫生健康委计划研究课题(编号:Z2013374)

摘　　要：目的探讨肺损伤预测评分(LIPS)≥4分指导有创机械通气时机治疗慢性阻塞性肺疾病急性加重期(AECOPD)并呼吸衰竭的可行性及疗效。方法采用前瞻性对照研究方法选取广西壮族自治区人民医院急诊科2015年2月至2016年12月收治的AECOPD并呼吸衰竭患者41例,按信封法随机分为观察组22例和对照组19例,其中观察组入院后每隔2 h进行LIPS评分,当LIPS≥4分时进行气管插管有创机械通气;对照组根据AECOPD诊治指南出现有创性机械通气的应用指征时予气管插管有创机械通气。两组均给予小潮气量机械辅助通气治疗,动态观察两组患者机械通气治疗后呼吸力学指标、炎性指标、ICU住院时间、机械辅助通气时间、急性呼吸窘迫综合征(ARDS)发生率、呼吸机相关性肺炎(VAP)发生率。结果观察组和对照组患者治疗前的年龄和病程相仿,差异均无统计学意义(P>0.05);通气治疗48 h后,观察组和对照组患者肺顺应性分别为(52.12±4.45)mL/cm H_2O和(47.60±2.75)mL/cm H_2O,气道峰压分别为(20.28±3.12)cm H_2O和(24.32±3.78)cm H_2O,血清白细胞介素-6分别为(25.84±2.85)ng/L和(27.32±3.63)ng/L,C-反应蛋白分别为(14.85±2.05)ng/L和(17.30±4.55)ng/L,机械通气时间分别为(6.48±0.82)d和(8.28±1.20)d,住院治疗时间分别为(13.12±3.51)d和(15.00±4.36)d,VAP发生例数分别为4和6例,经统计学分析,上述各项指标比较差异均有统计学意义(P<0.05);观察组和对照组患者发生ARDS分别为0例和1例,差异无统计学意义(P>0.05)。结论以肺损伤预测评分≥4分指导机械通气时机结合小潮气量机械辅助通气治疗可以改善AECOPD患者的临床指标,降低VAP发生率,具有良好的临床可操作性。Objective To explore the feasibility and efficacy of invasive mechanical ventilation at lung injury prediction score（LIPS）≥4 in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） complicating respiratory failure. Methods In a prospective controlled study, 41 AECOPD patients with respiratory failure in the People’s Hospital of Guangxi Zhuang Autonomous Region from Feb. 2015 to Dec. 2016 were divided into observation group（22 patients） and control group（19 patients） according to envelope method. In the observation group, LIPS was evaluated every 2 hours after admission, and invasive mechanical ventilation was performed at LIPS≥4. In the control group, invasive mechanical ventilation was applied when there were indications according to AECOPD guide. The two groups were given mechanical ventilation with small tidal volume. The respiratory mechanics indexes after mechanical ventilation, inflammatory indicators, length of ICU stay, ventilation time, incidence of acute respiratory syndrome（ARDS）, and incidence of ventilator associated pneumonia（VAP） were dynamically observed. Results Age and course of disease were similar in the observation group and the control group（P〉0.05）. After ventilation for 48 hours, the lung compliance were（52.12 ± 4.45） mL/cm H2O in the observation group versus（47.60 ± 2.75） mL/cm H2O in the control group, and airway peak pressure（20.28±3.12） cm H2O versus（24.32±378） cm H2O, interleukin-6（25.84±2.85） ng/L versus（27.32 ± 3.63） ng/L, C-reactive protein（14.85 ± 2.05） ng/L versus（17.30 ± 4.55） ng/L, mechanical ventilation time（6.48±0.82） d versus（8.28±1.20） d, length of length of ICU stay（13.12±3.51） d versus（15.00±4.36） d, VAP 4 cases versus 6 cases. The differences were statistically significant（P〈0.05）. There were 0 case in the observation group versus 1 case in the control group of ARDS（P〉0.05）. Conclusion Time of invasive mechanical ventilation at LIPS≥4

关 键 词：慢性阻塞性肺疾病急性加重期 呼吸衰竭 肺损伤预测评分 机械通气 

分 类 号：R563[医药卫生—呼吸系统]