无创机械通气在胡蜂螫伤并急性呼吸窘迫综合征患者中的应用研究  

Application of noninvasive mechanical ventilation in patients with wasp sting and acute respiratory distress syndrome

作　　者：郭辉 钟燕 李昌盛 柴林 段辉 段斌 梁鹏飞 杨贤义 方志成 GUO Hui;ZHONG Yan;LI Changsheng;CHAI Lin;DUAN Hui;DUAN Bin;LIANG Pengfei;YANG Xianyi;FANG Zhicheng(Department of Emergency,Shiyan Taihe Hospital(Hospital Afliated to Hubei University of Medicine,Shiyan 442000,Hubei,China)

机构地区：[1]十堰市太和医院(湖北医药学院附属医院),湖北十堰442000

出　　处：《中国急救复苏与灾害医学杂志》2020年第7期844-846,852,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：湖北省十堰市科学技术研究与开发项目(编号:15Y25,16Y28)。

摘　　要：目的观察胡蜂螯伤合并急性呼吸窘迫综合征(ARDS)患者无创机械通气的疗效,分析影响其治疗效果的有关因素,更好的指导临床选择机械通气的策略。方法回顾性分析2016年8月一2018年9月湖北省十堰市太和医院EICU收治蜂螯伤合并ARDS的患者病历资料。根据患者接受无创机械通气治疗后是否调整为有创机械通气将患者分为无创治疗失败组与治疗成功组,比较两组患者年龄、性别、蜂螫伤的针刺皮损数、急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、序贯器官功能衰竭评分(SOFA)、超敏C反应蛋白(hsCRP)、血清乳酸(Lac)、降钙素原(PCT)、氧和指数(PaO22/FiO2)结果等。结果共纳入31例患者,治疗失败组12例,治疗成功组19例。两组年龄、性别比较,差异均无统计学意义(P>0.05)。单因素分析显示,治疗失败组APACHE Ⅱ评分、SOFA评分、超敏C反应蛋白(hsCRP)、血清乳酸(Lac)、降钙素原(PCT)均高于治疗成功组。多因素Logistic回归分析显示PaO2/FiO2,<130、SOFA>9分是治疗失败的独立危险因素。结论无创机械通气对胡蜂螫伤合并ARDS患者有一定的应用价值,但对于蜂螫伤PaO2/FiO2,<130..SOFA>9分的患者优先考虑给予有创机械通气。Objective To observe the eficacy of non-invasive mechanical ventilation in patients with wasp sting and acute respiratory distress syndrome(ARDS),to analyze the factors afeeting the therapeutic efct,and to better guide the clinical selection of mechanical ventilation.Methods A retrospective analysis of the medical records of patients with wasp stings and ARDS admitted to EICU,Taihe Hospital of Shiyan City,Hubei Prov ince from August 2016 to Septem-ber 2018.Patients were divided into non-invasive treatment failure group and treatment success group according to whether they were adjusted to invasive mechanical ventilation after non-invasive mechanical ventilation treatment.The age,sex,number of acupuneture lesions of bee stings,acute physiology and chronicity were compared between the two groups.Health Status Score System Ⅱ(APACHE Ⅱ)score,sequential organ failure score(SOF A),hypersensitive C-reactive protein(hsCRP).serum laclate(Lac),procaleitonin(PCT),oxygen and index(PaO2/FiO2)results,ete.Results A total of 31 patients were included,12 in the treatment failure group and 19 in the successful treatment group.There were no significant differences in age and gender between the two groups(P>0.05).Univariate analysis showed that APACHE Ⅱ score,SOFA score,high-sensitivity C-reactive protein(hsCRP),serum lactate(Lac),and procaleitonin(PCT)were higher in the treatment failure group than in the suecessful treatment group.Multivariate logistic regression analysis showed that PaO2/FiO2,<130 and SOF A>9 scores were independent risk factors for treatment failure.Conclusion Non-invasive mechanical ventilation has certain application value for patients with wasp sting and ARDS,but it is preferred to give invasive mechanical ventilation for patients with PaO2/FiO2 less than 130 and SOFA greater than 9 points.

关 键 词：无创机械通气 蜂螫伤 急性呼吸窘迫综合征 

分 类 号：R563.8[医药卫生—呼吸系统]