不同通气方式对急性加重慢性阻塞性肺疾病患者呼吸道病毒分布及预后的影响  

Effects of different types of ventilation on the distribution of respiratory viruses and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：刘丹 范惠君 武亚莉 李慧敏 刘旭 LIU Dan;FAN Hui-jun;WU Ya-li;LI Hui-min;LIU Xu(Department of Respiratory and Critical Care Medicine,Wuhan Fifth Hospital,Wuhan Fifth Hospital,Wuhan 430050,Hubei,China)

机构地区：[1]武汉市第五医院呼吸与危重症医学科,湖北武汉430050

出　　处：《中国病原生物学杂志》2021年第7期822-825,共4页Journal of Pathogen Biology

基　　金：武汉市医学科研项目(No.WX19C01)。

摘　　要：目的探讨不同通气方式对急性加重慢性阻塞性肺疾病(AECOPD)患者呼吸道病毒分布及预后的影响。方法选取2018年10月-2020年10月本院收治的AECOPD患者194例,采用随机数字表法并按照1∶1的比例将其分为无创机械通气(NIV)组97例和有创机械通气(IMV)组97例。NIV组患者在常规治疗基础上使用飞利浦伟康BiPAP呼吸机面罩吸氧,IMV组患者在常规治疗基础上经气管内插管进行机械通气。收集两组患者临床资料进行比较分析;采用实时荧光定量PCR检测鼻咽拭子标本中甲型流感病毒(FLU-A)、乙型流感病毒(FLU-B)、副流感病毒(PIV)、腺病毒(ADV)、呼吸道合胞病毒(RSV),分析IMV患者不同季节、不同机械通气时间病毒感染分布情况。结果 IMV组患者总机械通气时间、住院时间及病毒总检出率均大于NIV组患者(均P<0.05);检出病毒感染20例,其中单一病毒感染占70.00%(14/20),以FLU-A、FLU-B感染常见;混合感染占30.00%(6/20),其中FLU-A+FLU-B及FLU-B+PIV感染各占10.00%,PIV+RSV及ADV+RSV感染各占5.00%。IMV组患者季节病毒检出率由高到低为冬季、秋季、春季、夏季。随机械通气时间增加,IMV组患者FLU-A、FLU-B、PIV、ADV及RSV病毒感染数量均逐渐增加。IMV组病毒感染患者住院病死率为25.00%,与未感染患者病死率5.19%比较差异有统计学意义(P<0.05)。结论接受IMV治疗的AECOPD患者病毒总检出率高于NIV患者,且主要为单一病毒感染,临床上应根据病毒分布特点采取相应预防和治疗措施,以改善患者预后。Objective To investigate the effects of different types of ventilation on the distribution of respiratory viruses and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods Subjects were a total of 194 patients with AECOPD seen at this hospital from October 2018 to October 2020. Subjects were randomly divided into a noninvasive mechanical ventilation(NIV) group(97 patients) and an invasive mechanical ventilation(IMV) group(97 patients) according to a random number table in a ratio of 1:1. In accordance with conventional treatment, patients in the NIV group were given oxygen with a Philips Respironics BiPAP ventilator mask while patients in the IMV group underwent endotracheal intubation and mechanical ventilation. Clinical data on the two groups were collected for comparative analysis. Nasopharyngeal swab specimens were tested for influenza A(FLU-A), influenza B(FLU-B), parainfluenza virus(PIV), adenovirus(ADV), and respiratory syncytial virus(RSV) using real-time quantitative PCR. The distribution of viral infections in patients with IMV during different seasons and the time on mechanical ventilation was analyzed. Results The total time on mechanical ventilation, the duration of hospitalization, and the overall rate of virus detection in the IMV group were longer or higher than those in the NIV group(P<0.05 for all). A viral infection was detected in 20 patients;a single viral infection was detected in 70.00%(14/20) of those patients. An infection with FLU-A or FLU-B was common, and a mixed infection was detected in 30.00%(6/20) of patients. An infection with FLU-A + FLU-B was detected in 10.00% of patients, and a FLU-B + PIV infection was detected in 10.00%. An infection with PIV + RSV was detected in 5.00% of patients, and an infection with adv + RSV infection was detected in 5.00%. The rate of seasonal detection of a virus in the IMV group went from high to low during the winter, autumn, spring, and summer. As the time on mechanical ventilation increased, the n

关 键 词：慢性阻塞性肺疾病 急性加重 无创机械通气 有创机械通气 呼吸道病毒 

分 类 号：R373.1[医药卫生—病原生物学]