有创-无创序贯机械通气用于重症呼吸衰竭中的效果研究  

Study on effect of invasive and noninvasive sequential mechanical ventilation in patients with severe respiratory failure

作　　者：曾慧志 曾广志[1] 梅林[1] 陈海玉[1] ZENG Hui-zhi;ZENG Guang-zhi;MEI Lin(Intensive Care Unit,Liuzhou Liutie Central Hospital,Liuzhou 545007,China)

机构地区：[1]柳州市柳铁中心医院重症医学科,545007

出　　处：《中国实用医药》2024年第5期24-28,共5页China Practical Medicine

摘　　要：目的探究对重症呼吸衰竭患者实施有创-无创序贯机械通气的效果。方法86例重症呼吸衰竭患者作为研究对象,采用随机数表法分为对照组及观察组,每组43例。对照组实施传统有创机械通气治疗,观察组实施有创-无创序贯机械通气治疗。对比两组患者治疗前后的血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))]及肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、最大呼气峰流速(PEF)]水平,治疗时间(有创通气时间、总机械通气时间)和住院时间,治疗后的应激反应指标[去甲肾上腺素(NE)、肾上腺素(E)、血管紧张素Ⅱ(ATⅡ)]、生命体征(心率、呼吸频率),撤机成功率、再次插管率、呼吸机相关肺炎发生率。结果两组患者治疗后的PaO_(2)、SaO_(2)高于本组治疗前,PaCO_(2)低于本组治疗前,且观察组的PaO_(2)(73.03±5.35)mm Hg(1 mm Hg=0.133 kPa)、SaO_(2)(92.46±4.60)%高于对照组的(66.24±4.97)mm Hg、(85.18±3.79)%,PaCO_(2)(41.09±0.54)mm Hg低于对照组的(44.98±0.63)mm Hg(P<0.05)。两组患者治疗后的FEV1、FVC、PEF高于本组治疗前,且观察组的FEV1(3.21±0.34)L、FVC(3.89±0.29)L、PEF(3.35±0.60)L/s高于对照组的(2.29±0.24)L、(2.74±0.21)L、(2.90±0.71)L/s(P<0.05)。观察组有创通气时间、总机械通气时间、住院时间分别为(6.07±1.21)、(8.70±1.53)、(12.33±1.82)d,比对照组的(11.46±1.77)、(11.46±1.77)、(18.64±2.35)d更短(P<0.05)。观察组治疗后应激反应指标NE、E、ATⅡ水平分别为(122.80±17.92)ng/ml、(94.52±8.52)ng/ml、(31.05±2.98)pg/ml,比对照组的(209.59±21.06)ng/ml、(164.45±11.67)ng/ml、(55.69±4.13)pg/ml更低(P<0.05)。观察组治疗后心率为(88.21±4.87)次/min、呼吸频率为(15.98±0.81)次/min,低于对照组的(95.70±6.13)、(19.59±1.25)次/min(P<0.05)。观察组撤机成功率93.02%(40/43)高于对照组的72.09%(31/43),再次插管率2.33%(1/43)、呼吸机Objective To exploer the effect of invasive and noninvasive sequential mechanical ventilation in patients with severe respiratory failure.Methods 86 patients with severe respiratory failure were divided into a control group and an observation group by random number table method,with 43 cases in each group.The control group was treated with conventional invasive mechanical ventilation,and the observation group was treated with invasive and noninvasive sequential mechanical ventilation.Both groups were compared in terms of blood gas analysis indicators[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),arterial oxygen saturation(SaO_(2))]and lung function indicators[forced expiratory volume in one second(FEV1),forced vital capacity(FVC),peak expiratory flow rate(PEF)]before and after treatment,treatment duration(duration of invasive ventilation,total duration of mechanical ventilation),length of hospital stay,stress response indicators[norepinephrine(NE),epinephrine(E),angiotensinⅡ(ATⅡ)],vital signs(heart rate,respiratory rate)and therapeutic effect(success rate of ventilation weaning,re-intubation rate,incidence of ventilator-associated pneumonia)after treatment.Results After treatment,PaO_(2) and SaO_(2) in both groups were higher than those before treatment,and PaCO_(2) was lower than that before treatment;PaO_(2) of(73.03±5.35)mm Hg(1 mm Hg=0.133 kPa)and SaO_(2) of(92.46±4.60)%in the observation group were higher than(66.24±4.97)mm Hg and(85.18±3.79)%in the control group;PaCO_(2) of(41.09±0.54)mm Hg in the observation group was lower than(44.98±0.63)mm Hg in the control group(P<0.05).After treatment,FEV1,FVC and PEF in both groups were higher than those before treatment;the observation group had FEV1 of(3.21±0.34)L,FVC of(3.89±0.29)L and PEF of(3.35±0.60)L/s,which were higher than(2.29±0.24)L,(2.74±0.21)L and(2.90±0.71)L/s in the control group(P<0.05).The duration of invasive ventilation,total duration of mechanical ventilation and length of hospit

关 键 词：有创机械通气 重症呼吸衰竭 有创-无创序贯机械通气 血气分析指标 

分 类 号：R563.8[医药卫生—呼吸系统]