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(PaCO2)、血氧饱和指数(SaO2)、血氧分压(PaO2)、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、PaCO2、SaO2、PaO2、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(x2=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.
Abstract
Objective To explore the clinical efficacy of invasive-noninvasive sequential mechanical ventilation in treating respira-tory 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 accord-ing to the different treatments,Among them,26 patients treated with sequential non-invasive mechanical ventilation were in the obser-vation 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(PaCO2),oxygen saturation index(Oxygen),partial pressure of oxygen(PaO2)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,PaCO2,SaO2,PaO2 and pH of the observation group were significantly better than those of the control group,and the differences were statistically sig-nificant(all P＜0.05).In the observation group,the time of invasive mechanical ventilation[(4.17±2.02)d],the total time of me-chanical ventilation[(7.21±2.79)d],the time of staying in respiratory intensive care unit[(8.73±3.05)d]and the length of hos-pitalization[(12.56±4.36)d]were shorter than the control group.The difference was statistically significant(all P＜0.05).Compa-ring the incidence of complications between the two groups,the incidence of ventilator-associated pneumonia in the observation group was 3.85％,significantly lower than the 27.27％in the control group,the difference was statistically significant(P＜0.05).However,the two groups were compared in reintubation rates and hospital mortality.There was no significant difference(all P＞0.05).There was no significant difference in the satisfaction of treatment and care groups(x2=2.624,P=0.111).Conclusion When treating pa-tients from snakebite of Bungarus multicinctus to respiratory paralysis,timely use of anti-toxin serum and mechanical ventilation can ef-fectively treat the patient.When the patient's condition improves,invasive-noninvasive sequential mechanical ventilation can improve the patients blood gas faster Indicators to reduce patient treatment time.
基金项目
柳州市科学研究与技术开发计划(2017BH20302)
维普
万方数据