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有创-无创序贯机械通气用于重症呼吸衰竭中的效果研究

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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(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)]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PaO2、SaO2 高于本组治疗前,PaCO2 低于本组治疗前,且观察组的PaO2(73.03±5.35)mm Hg(1 mm Hg=0.133 kPa)、SaO2(92.46±4.60)%高于对照组的(66.24±4.97)mm Hg、(85.18±3.79)%,PaCO2(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)、呼吸机相关肺炎发生率4.65%(2/43)低于对照组的 18.60%(8/43)、20.93%(9/43)(P<0.05).结论 在重症呼吸衰竭患者治疗中,行有创-无创序贯机械通气治疗疗效确切,有助于加快患者病情康复速度,促进患者血气分析指标、肺功能改善,减轻患者应激反应,提升撤机成功率,降低呼吸机相关肺炎发生风险,推广可行性较高.
Study on effect of invasive and noninvasive sequential mechanical ventilation in patients with severe respiratory failure
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(PaO2),arterial partial pressure of carbon dioxide(PaCO2),arterial oxygen saturation(SaO2)]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),angiotensin Ⅱ(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,PaO2 and SaO2 in both groups were higher than those before treatment,and PaCO2 was lower than that before treatment;PaO2 of(73.03±5.35)mm Hg(1 mm Hg=0.133 kPa)and SaO2 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;PaCO2 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 hospital stay in the observation group were(6.07±1.21),(8.70±1.53)and(12.33±1.82)d,which were shorter than(11.46±1.77),(11.46±1.77)and(18.64±2.35)d in the control group(P<0.05).After treatment,the levels of stress response indexes of NE,E and ATⅡ in the observation group were(122.80±17.92)ng/ml,(94.52±8.52)ng/ml and(31.05±2.98)pg/ml,which were lower than(209.59±21.06)ng/ml,(164.45±11.67)ng/ml and(55.69±4.13)pg/ml in the control group(P<0.05).After treatment,the heart rate and respiratory rate of the observation group were(88.21±4.87)beats/min and(15.98±0.81)times/min,which were lower than(95.70±6.13)beats/min and(19.59±1.25)times/min of the control group(P<0.05).The success rate of ventilation weaning of 93.02%(40/43)in the observation group was higher than 72.09%(31/43)in the control group;the re-intubation rate in the observation group was 2.33%(1/43)and the incidence of ventilator-associated pneumonia was 4.65%(2/43),which were lower than 18.60%(8/43)and 20.93%(9/43)in the control group(P<0.05).Conclusion In the treatment of patients with severe respiratory failure,the therapeutic effect of invasive and non-invasive sequential mechanical ventilation is accurate,which can help speed up the recovery of patients,promote the improvement of blood gas analysis indicators and lung function of patients,reduce the stress response of patients,improve the success rate of ventilation weaning,reduce the risk of ventilator-associated pneumonia,and has high feasibility for promotion.

Invasive mechanical ventilationSevere respiratory failureInvasive and non-invasive sequential mechanical ventilationBlood gas analysis indicators

曾慧志、曾广志、梅林、陈海玉

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545007 柳州市柳铁中心医院重症医学科

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

2024

中国实用医药
中国康复医学会

中国实用医药

影响因子:0.797
ISSN:1673-7555
年,卷(期):2024.19(5)
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