俯卧位机械通气对重症肺炎呼吸衰竭并发呼吸机相关肺炎的影响  

Effects of prone mechanical ventilation on severe respiratory failure complicated with ventilator-associated pneumonia

作　　者：张慧慧[1] 胡月红[1] 周尧英[1] 王伟钟 王志娟[2] ZHANG Hui-hui;HU Yue-hong;ZHOU Yao-ying;WANG Wei-zhong;WANG Zhi-juan(Shaoxing Peopled Hospital,Shaoxing,Zhejiang 312000,China)

机构地区：[1]绍兴市人民医院重症医学科,浙江绍兴312000 [2]绍兴市人民医院护理部,浙江绍兴312000

出　　处：《中华医院感染学杂志》2020年第24期3734-3738,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2020KY328)。

摘　　要：目的分析俯卧位机械通气对重症肺炎并呼吸衰竭患者可溶性髓样细胞触发受体1(Soluble myeloid cell triggering receptor 1,sTREM-1)、超敏C-反应蛋白(hypersensitive-c-reactive-proteihs-C,hs-CRP)、白细胞介素-8(Interleukin-8,IL-8)的影响及VAP感染的危险因素。方法选取2018年7月-2019年12月绍兴市人民医院重症医学科收治的重症肺炎并呼吸衰竭患者60例,采用随机数字表法分为对照组和试验组,各30例。两组均行常规治疗,对照组采用常规仰卧位机械通气,试验组采用俯卧位机械通气,两组均行机械通气治疗5 d。比较两组治疗前后肺功能、生化指标及病情进展。观察重症肺炎并呼吸衰竭发生VAP感染情况,收集其临床资料,通过多因素Logistic回归分析重症肺炎并呼吸衰竭患者发生VAP感染的危险因素。结果治疗后与治疗前比较,两组PaO2、Cdyn水平升高,试验组高于对照组(P<0.05);PaCO2水平降低,试验组低于对照组(P<0.05)。治疗后与治疗前比较,两组血清sTREM-1、hs-CRP、血乳酸、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及心率水平降低,试验组患者低于对照组(P<0.05)。重症肺炎并呼吸衰竭患者VAP感染发生率为23.33%。多因素Logistic回归分析结果显示,气管切开、住院时间≥3 d、原发肺部疾病均为VAP感染的独立危险因素(P<0.05),丙种球蛋白使用为VAP感染的保护因素(P<0.05)。结论俯卧位机械通气可降低重症肺炎并呼吸衰竭患者sTREM-1、hs-CRP、IL-8水平,提高肺功能,改善生理指标,控制病情进展;根据重症肺炎并呼吸衰竭患者发生VAP感染的危险因素,临床可进行针对性干预。OBJECTIVE To analyze the effects of prone mechanical ventilation on sTREM-1,hs-CRP,IL-8 and risk factors of VAP infection in patients with severe pneumonia and respiratory failure.METHODS Between Jul.2018 and Dec.2019,60 patients with severe pneumonia and respiratory failure treated in Shaoxing people’s Hospital’s Department of Critical Medicine were divided into the control group and the observation group by random number assay,each group with 30 patients.Both groups received routine treatment.The control group received conventional supine mechanical ventilation,and the observation group received prone mechanical ventilation.Both groups received mechanical ventilation for 5 days.Lung function,biochemical indicators,and disease progression were compared between the two groups before and after the treatment.VAP infection in patients with severe pneumonia and respiratory failure were observed,clinical data were collected,and risk factors for VAP infection in patients with severe pneumonia and respiratory failure were analyzed by multivariate Logistic regression analysis.RESULTS Compared with before the treatment,the levels of PaO2 and Cdyn in the two groups increased after the treatment,and the indexes in the observation group were significantly higher than that in the control group(P<0.05);PaCO2 level in the observation group was significantly lower than that in the control group(P<0.05).Compared with before the treatment,the serum sTREM-1,hs-CRP,blood lactic acid,APACHEⅡscore and heart rate in the two groups were significantly lower than that in the control group(P<0.05).The incidence of VAP infection in patients with severe pneumonia and respiratory failure was 23.33%.Multivariate Logistic regression analysis showed that tracheotomy,length of hospitalization≥3 d and primary lung disease were the independent risk factors for VAP infection(P<0.05),and the use of gamma globulin was VAP protective factors for infection(P<0.05).CONCLUSION Prone position mechanical ventilation can reduce the levels of sTREM-1,

关 键 词：重症肺炎 呼吸衰竭 体位 机械通气 可溶性髓样细胞触发受体1 呼吸机相关肺炎 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]