降钙素原变化率对AECOPD合并呼吸衰竭患者序贯机械通气切换时机的应用价值  

Application value of PCT change rate on switching time of sequential mechanical ventilation in patients with AECOPD complicated with respiratory failure

作　　者：陈苍宋 张君利[1] 贺洁 陶毅强[1] CHEN Cang-song;ZHANG Jun-li;HE Jie;TAO Yi-qiang(Department of Respiratory and Critical Care Medicine,Taizhou Hospital of Traditional Chinese Medicine,Taizhou,Zhejiang 318000,China)

机构地区：[1]台州市中医院呼吸与危重症医学科,浙江台州318000

出　　处：《医药论坛杂志》2022年第15期52-55,60,共5页Journal of Medical Forum

摘　　要：目的探讨降钙素原(procalcitonin,PCT)变化率对慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者序贯机械通气切换时机的应用价值。方法选取台州市中医院2019年8月至2020年12月诊治的AECOPD合并呼吸衰竭患者140例,随机分为观察组和对照组各70例。观察组将血清PCT变化率>50%作为拔管时机,对照组将肺部感染控制窗作为拔管时机。比较两组临床疗效以及干预前后CRP、IL-6、TNF-α、PaCO_(2)、PaO_(2)和Lac水平。结果干预后观察组CRP、TNF-α和IL-6水平均低于对照组(P<0.05)。PaCO_(2)、PaO_(2)和Lac水平两组之间无显著差异(P>0.05)。观察组有创通气时间、总机械通气时间、呼吸危重症住院时间、总住院时间,以及呼吸机相关肺炎、48h再插管、上消化道出血和死亡的发生率均明显低于对照组(P<0.05)。结论在序贯机械通气中,血清PCT变化率>50%可以作为序贯机械通气的切换点。Objective To explore the application value of procalcitonin(PCT)change rate on the switching time of sequential mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure.Methods Totally 140 patients with AECOPD complicated with respiratory failure treated from August 2019 to December 2020 were randomly divided into observation group and control group.The observation group took the change rate of serum PCT>50%as the time of extubation,and the control group took the pulmonary infection control window as the time of extubation.The clinical efficacy and CRP,IL-6 and TNF before and after intervention were compared between the two groups-α,PaCO_(2),PaO_(2)and Lac levels.Results After the intervention,CRP and TNF in the observation group-αAnd IL-6 water were lower than those in the control group(P<0.05).There was no significant difference in the levels of PaCO_(2),PaO_(2)and Lac between the two groups(P>0.05).The invasive ventilation time,total mechanical ventilation time,hospitalization time of respiratory critical illness,total hospitalization time,and the incidence of ventilator-associated pneumonia,48 h reintubation,upper gastrointestinal bleeding and death in the observation group were significantly lower than those in the control group(P<0.05).Conclusion In sequential mechanical ventilation,the change rate of serum PCT>50%can be used as the switching point of sequential mechanical ventilation.

关 键 词：呼吸衰竭 序贯机械通气 降钙素原 慢性阻塞性肺疾病急性加重 

分 类 号：R563.8[医药卫生—呼吸系统]