老年重症肺炎合并呼吸衰竭患者不同撤机方式的效果比较  

Comparison of effects of different weaning modes for elderly patients with severe pneumonia and respiratory failure

作　　者：耿兴二[1] 唐安华[1] Geng Xinger;Tang Anhua(Intensive Care Unit,Affiliated Chaohu Hospital of Anhui Medical University,Chaohu 238000,China)

机构地区：[1]安徽医科大学附属巢湖医院重症医学科,巢湖238000

出　　处：《中华肺部疾病杂志（电子版）》2018年第4期456-459,共4页Chinese Journal of Lung Diseases(Electronic Edition)

摘　　要：目的比较(有创-无创)序贯通气和同步间歇指令+压力支持通气(SIMV+PSV)在老年重症肺炎合并呼吸衰竭患者撤机过程中的影响。方法选择2012年1月至2017年12月安徽医科大学附属巢湖医院重症医学科收治的老年重症肺炎合并呼吸衰竭的60例患者,采取单纯随机方法分为观察组30例和对照组30例。观察组患者采用(有创-无创)序贯机械通气方式撤机,对照组患者采用SIMV+PSV方式撤机。比较两组患者撤机成功率、有创通气时间、总共机械通气时间、ICU住院时间、呼吸机相关性肺炎(VAP)发生率及两组患者开始撤机后2 h、1 d和3 d呼吸频率和氧合指数(PaO_2/FiO_2)。结果观察组患者撤机成功率为86.67%(26/30),呼吸机相关性肺炎发生率为6.67%(2/30),ICU住院时间(10.6±3.7)d,有创通气时间为(6.8±2.4)d、总共机械通气时间(9.4±2.2)d。对照组撤机成功率为60.0%(18/30),VAP发生率为26.67%(8/30),ICU住院时间(18.5±4.6)d,有创通气时间为(14.8±3.6)d、总共机械通气时间(14.8±3.6)d。两组比较差异有统计学意义(P<0.05)。两组患者开始撤机后2 h、1 d和3 d呼吸频率和氧合指数(PaO_2/FiO_2)比较差异无统计学意义(P>0.05)。结论序贯机械通气可提高老年重症肺炎合并呼吸衰竭患者撤机成功率,减少并发症。Objective To compare the effects of sequential ventilation and synchronous intermittent instruction ventilation plus pressure support ventilation（ SIMV ＋ PSV） during the respirator withdrawal for the patients with severe pneumonia complicated with respiratory failure. Methods A total of 60 elderly patients with severe pneumonia and respiratory failure treated in our hospital from January 2012 to December 2017 were randomly divided into two groups. The observation group（ n = 30） was treated with sequential mechanical ventilation（ invasive or non-invasive） during the respirator withdrawal,and the control group（ n = 30） was withdrawn by SIMV ＋ PSV. It was compared that the achievement ratio of withdrawal,the time of invasive ventilation,the total mechanical ventilation time,the time of ICU hospitalization,the incidence of respiratoryassociated pneumonia,and the respiratory rate and oxygenation index（ Pa O2/Fi O2） 2 h,1 day and 3 days after withdrawal of the respirator of the two groups. Results In the observation group,the achievement ratio was86.67%（ 26/30）, the incidence of respiratory-related pneumonia was 6. 67%（ 2/30）, the time of hospitalization of ICU was（ 10.6±3.7） days,the time of invasive ventilation was（ 6.8±2.4） days,and the total mechanical ventilation time was（ 9. 4 ± 2. 2） days; while in the control group,they were 60. 0%（ 18/30）,26.67%（ 8/30）,（ 18.5 ± 4. 6） days,（ 14. 8 ± 3. 6） days,（ 14. 8 ± 3. 6） days,respectively. The difference between the two groups was statistically significant（ P〈0.05）. However,there was no significant difference in the respiratory frequency and the oxygenation index（ Pa O2/Fi O2） 2 h,1 day and 3 days after withdrawal of the respirator between the two groups（ P〉0.05）. Conclusion Sequential mechanical ventilation can improve the rate of successful weaning and reduce complications during the respirator withdrawal in elderly patients with severe pneumonia and respiratory failure.

关 键 词：老年重症肺炎 呼吸衰竭 序贯通气 同步间歇指令+压力支持通气 

分 类 号：R563[医药卫生—呼吸系统]