慢性阻塞性肺疾病并呼吸衰竭患者行降钙素原检测对序贯治疗切换点应用研究  

Study on procalcitonin detection as a switching point for sequential ventilation in patients with chronic obstructive pulmonary disease complicated with respiratory failure

作　　者：钟春苗[1] 嵇朝晖[1] 胡先全[1] 潘慧斌[1] ZHONG Chunmiao;JI Zhaohui;HU Xianquan;PAN Huibin(Emergency Department ICU,the First People’s Hospital of Huzhou in Zhejiang Province,Huzhou　313000,China)

机构地区：[1]浙江省湖州市第一人民医院急诊科ICU,浙江湖州313000

出　　处：《中国现代医生》2018年第7期82-85,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划(2018KY773)

摘　　要：目的探讨对慢性阻塞性肺疾病合并呼吸衰竭患者检测其降钙素原,利用降钙素原窗(PCT窗)作为患者接受有创-无创序贯通气治疗切换点的应用价值。方法研究对象为2015年6月～2017年6月我院住院治疗的慢阻肺合并呼吸衰竭的80例患者,根据随机数表法将患者分为两组。观察组患者根据血清PCT检测结果待PCT窗出现后及时对观察组患者将有创通气治疗转变为经鼻/口面罩实施无创正压机械通气(NIPPV)治疗。而对照组患者则同步实施压力支持通气(PSV)+间歇强制通气(SIMV)治疗模式,并逐步过渡到PSV通气治疗继续接受有创机械通气。结果观察组患者有创通气时间、总通气时间、ICU治疗时间及住院时间均较对照组短,差异有统计学意义(P<0.05);观察组呼吸机相关性肺炎发生率、再次插管率均低于对照组,差异有统计学意义(P<0.05)。结论慢性阻塞性肺疾病合并呼吸衰竭患者有创-无创序贯通气治疗期间以PCT窗作为切换点,利于缩短患者通气治疗时间和减少通气期间呼吸机相关性肺炎的发生,可提高通气治疗的有效性及安全性。Objective To explore the application value of procalcitonin(PCT)window as a switching point for invasive to noninvasive sequential ventilation in patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods A total of 80 patients with chronic obstructive pulmonary disease complicated with respiratory failure were selected from those who had been admitted to the hospital between June 2015 and June 2017.Patients were divided into two groups according to random number table method.In the observation group,Invasive ventilation treatment for patients was converted to nasal/mouth mask noninvasive positive pressure ventilation(NIPPV)after the emergence of PCT window.In the control group,pressure support ventilation(PSV)plus synchronized intermittent mandatory ventilation(SIMV)treatment was conducted on patients simultaneously,and gradually transferred to the PSV to continue the invasive mechanical ventilation.Results The invasive mechanical ventilation time,total mechanical ventilation time,ICU treatment duration and length of hospital stay in the observation group were shorter than those in the control group,and the difference was statistically significant(P<0.05);the incidence of ventilator-associated pneumonia and reintubation rate in the observation group were both lower than the control group,and the difference was statistically significant(P<0.05).Conclusion For patients with chronic obstructive pulmonary disease complicated with respiratory failure,PCT window as a switching point for sequential invasive to noninvasive ventilation can shorten the time of ventilation,reduce the incidence of ventilator-associated pneumonia,and improve the efficacy and safety of ventilation.

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 降钙素原检测 序贯治疗 

分 类 号：R563.9[医药卫生—呼吸系统]