有创-无创序贯机械通气救治银环蛇咬伤致呼吸肌麻痹的临床研究  

Clinical study of sequential invasive-noninvasive mechanical ventilation in the treatment of respiratory muscle paralysis caused by snakebite of Bungarus multicinctus

作　　者：范海鹏 朱景法[1] 黄国亮 颜才荣 罗毅[3] FAN Haipeng;ZHU Jingfa;HUANG Guoliang;YAN Cairong;LUO Yi(Department of Emergency,Quanzhou First Hospital,Quanzhou City,Fujian Province,362000,China;Emergency Center,Anxi County Hospital,Quanzhou City,Fujian Province,362400,China;Department of Emergency,Liuzhou Hospital of Traditional Chinese Medicine,Liuzhou City,Guangxi Zhuang Autonomous Region,545001,China)

机构地区：[1]福建省泉州市第一医院急诊科,福建泉州362000 [2]福建省泉州市安溪县医院急诊中心,福建泉州362400 [3]广西壮族自治区柳州市中医院急诊科,广西柳州545001

出　　处：《蛇志》2024年第3期265-269,共5页Journal of Snake

基　　金：柳州市科学研究与技术开发计划(项目名称:桂中蛇伤图鉴与诊疗指南研究及推广应用,项目编号:2017BH20302)。

摘　　要：目的探讨有创-无创序贯机械通气救治银环蛇咬伤致呼吸肌麻痹的临床疗效。方法回顾性分析2011年9月至2021年3月我院收治的48例银环蛇咬伤并发呼吸衰竭患者的临床资料,并根据治疗方法的不同进行分组,其中采用有创后脱机拔除气管插管序贯无创机械通气治疗的26例患者为观察组,采用传统机械通气治疗的22例患者为对照组。分析两组患者的临床症状指标[呼吸频率(RR)、心率(HR)]以及二氧化碳分压(PaCO_(2))、血氧饱和指数(SaO_(2))、血氧分压(PaO_(2))、pH等血气指标,比较两组患者有创机械通气时间、总机械通气时间、住呼吸重症监护室时间、住院时间以及再插管率、住院死亡率、呼吸机相关性肺炎等并发症发生率、患者满意度情况。结果治疗前,两组患者的临床症状指标及血气指标水平比较,差异均无明显统计学意义(均P>0.05);治疗24 h后,两组患者的临床症状指标及血气指标均得到明显改善,观察组的RR、HR、PaCO_(2)、SaO_(2)、PaO_(2)、pH等指标改善均明显优于对照组,差异均有统计学意义(均P<0.05)。观察组的有创机械通气时间[(4.17±2.02)d]、总机械通气时间[(7.21±2.79)d],住呼吸重症监护室时间[(8.73±3.05)d]以及住院时间[(12.56±4.36)d]上均短于对照组,差异均有统计学意义(均P<0.05)。两组患者的并发症发生情况比较,观察组的呼吸机相关性肺炎发生率为3.85%,明显低于对照组的27.27%,差异有统计学意义(P<0.05);而两组患者的再插管率以及住院死亡率比较,差异均无统计学意义(均P>0.05)。两组患者在治疗护理的满意程度方面比较,差异无统计学意义(χ2=2.624,P=0.111)。结论在救治银环蛇咬伤至呼吸麻痹患者时,及时使用抗蛇毒血清及机械通气措施可有效改善患者临床指标,患者病情好转后采用有创-无创序贯机械通气治疗可更快地改善患者血气指标,减少患者治疗时间。Objective To explore the clinical efficacy of invasive-noninvasive sequential mechanical ventilation in treating respiratory muscle paralysis caused by snakebite of Bungarus multicinctus.Methods A retrospective analysis of 48 patients with snakebite of Bungarus multicinctus and respiratory failure admitted to our hospital from September 2011 to March 2021.And were grouped according to the different treatments,Among them,26 patients treated with sequential non-invasive mechanical ventilation were in the observation group,and The 22 patients treated with conventional mechanical ventilation were in the control group.The clinical data of the two groups were retrospectively analyzed[respiratory rate(RR),heart-rate(HR)],partial pressure of carbon dioxide(PaCO_(2)),oxygen saturation index(Oxygen),partial pressure of oxygen(PaO_(2))and pH were analyzed and compared between the two groups,Compared the incidence of invasive mechanical ventilation time,total mechanical ventilation time,respiratory intensive care unit stay,hospital stay time,reintubation rate,in-hospital mortality rate,ventilator-related pneumonia,and patient satisfaction.Results Before treatment,there was no significant difference between the clinical symptoms and blood gas index levels of the two groups(all P>0.05);After 24 h of treatment,the clinical symptoms and blood gas indexes of the two groups were significantly improved.The RR,HR,PaCO_(2),SaO_(2),PaO_(2)and pH of the observation group were significantly better than those of the control group,and the differences were statistically significant(all P<0.05).In the observation group,the time of invasive mechanical ventilation[(4.17±2.02)d],the total time of mechanical ventilation[(7.21±2.79)d],the time of staying in respiratory intensive care unit[(8.73±3.05)d]and the length of hospitalization[(12.56±4.36)d]were shorter than the control group.The difference was statistically significant(all P<0.05).Comparing the incidence of complications between the two groups,the incidence of ventilator-associated

关 键 词：蛇咬伤 机械通气 呼吸衰竭 中毒 

分 类 号：R646[医药卫生—外科学]