气管切开呼吸机依赖患者经有创-无创机械通气降级治疗的临床效果  

Clinical effect of invasive-noninvasive mechanical ventilation step-down therapy on patients with dysfunctional ventilatory weaning response

作　　者：陈衍红 CHEN Yan-hong(Dongda Hospital of Shanxian County,Heze 274300,China)

机构地区：[1]山东省单县东大医院,274300

出　　处：《中国实用医药》2024年第21期7-11,共5页China Practical Medicine

摘　　要：目的 研究气管切开呼吸机依赖(DVWR)患者经有创-无创机械通气降级治疗的临床价值。方法 95例DVWR患者,将其按照电脑随机数字表法分作观察组(47例)和对照组(48例)。对照组开展持续机械通气治疗,观察组则开展有创-无创机械通气降级治疗。对比两组患者治疗前后各项生命体征(收缩压、舒张压、心率、呼吸频率)、血气指标[动脉血氧分压(Pa O_(2))、动脉二氧化碳分压(Pa CO_(2))、p H值、剩余碱(BE)]、生活质量以及撤机成功率、重症加强护理病房(ICU)住院时长、住院死亡率。结果 治疗前,观察组患者收缩压为(122.42±7.94)mm Hg(1 mm Hg=0.133 k Pa)、舒张压为(70.42±3.45)mm Hg、心率为(87.11±4.21)次/min、呼吸频率为(20.17±3.02)次/min,对照组患者收缩压为(122.37±7.82)mm Hg、舒张压为(70.37±3.51)mm Hg、心率为(87.20±4.18)次/min、呼吸频率为(20.20±3.04)次/min;治疗24 h后,观察组患者收缩压为(121.76±8.01)mm Hg、舒张压为(70.48±3.26)mm Hg、心率为(88.60±4.55)次/min、呼吸频率为(21.33±3.16)次/min,对照组患者收缩压为(122.05±7.96)mm Hg、舒张压为(70.50±3.31)mm Hg、心率为(88.59±4.79)次/min、呼吸频率为(20.78±3.12)次/min。治疗前后两组患者收缩压、舒张压、心率、呼吸频率对比,差异均不明显(P>0.05)。治疗前,观察组患者Pa O_(2)为(95.22±10.30)mm Hg、Pa CO_(2)为(40.38±3.19)mm Hg、p H值为(7.51±0.12)、BE为(5.10±0.14)mmol/L,对照组患者Pa O_(2)为(95.05±10.27)mm Hg、Pa CO_(2)为(40.45±3.21)mm Hg、p H值为(7.51±0.13)、BE为(5.12±0.13)mmol/L;治疗24 h后,观察组患者Pa O_(2)为(92.48±8.37)mm Hg、Pa CO_(2)为(40.19±3.21)mm Hg、p H值为(7.53±0.13)、BE为(5.20±0.12)mmol/L,对照组患者Pa O_(2)为(93.11±8.42)mm Hg、Pa CO_(2)为(40.34±3.20)mm Hg、p H值为(7.52±0.14)、BE为(5.17±0.13)mmol/L。治疗前后,两组患者患者Pa O_(2)、Pa CO_(2)、p H值、BE对比,差异均不明显(P>0.05)。观察组撤机成功率48.94%高�Objective To study the clinical value of invasive-noninvasive mechanical ventilation step-down therapy on patients with dysfunctional ventilatory weaning response(DVWR).Methods 95 patients with DVWR were divided into an observation group(47 cases)and a control group(48 cases)according to computer random number table method.The control group was treated with continuous mechanical ventilation,and the observation group was treated with invasive and non-invasive mechanical ventilation step-down therapy.Patients in both groups were compared in terms of vital signs(systolic blood pressure,diastolic blood pressure,heart rate,respiratory rate),blood gas indicators[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),pH,base excess(BE)]and quality of life before and after treatment,success rate of ventilator weaning,length of intensive care unit(ICU)stay,and in-hospital mortality.Results Before treatment,the systolic blood pressure,diastolic blood pressure,heart rate and respiratory rate of the observation group were(122.42±7.94)mm Hg,(70.42±3.45)mm Hg(1 mm Hg=0.133 kPa),(87.11±4.21)beats/min and(20.17±3.02)times/min,the control group were(122.37±7.82)mm Hg,(70.37±3.51)mm Hg,(87.20±4.18)beats/min and(20.20±3.04)times/min.After 24 h of treatment,the systolic blood pressure,diastolic blood pressure,heart rate and respiratory rate of the observation group were(121.76±8.01)mm Hg,(70.48±3.26)mm Hg,(88.60±4.55)beats/min and(21.33±3.16)times/min,while those of the control group were(122.05±7.96)mm Hg,(70.50±3.31)mm Hg,(88.59±4.79)beats/min and(20.78±3.12)times/min.There were no significant differences in systolic blood pressure,diastolic blood pressure,heart rate and respiratory rate between two groups before and after treatment(P>0.05).Before treatment,PaO_(2),PaCO_(2),pH and BE of the observation group were(95.22±10.30)mm Hg,(40.38±3.19)mm Hg,(7.51±0.12)and(5.10±0.14)mmol/L,while those of the control group were(95.05±10.27)mm Hg,(40.45±3.21)mm Hg,(7.51±0.13)a

关 键 词：气管切开 呼吸机依赖 有创-无创机械通气降级治疗 作用价值 

分 类 号：R459.7[医药卫生—急诊医学]