肺结核合并呼吸衰竭行小潮气量机械通气的疗效分析被引量：7

Curative effect analysis of low tidal volume mechanical ventilation in pulmonary tuberculosis complicated with respiratory failure

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摘要目的探讨小潮气量机械通气与常规潮气量机械通气治疗肺结核合并呼吸衰竭的临床效果。方法选取2011年1月-2014年4月首都医科大学附属北京胸科医院收治的肺结核合并呼吸衰竭患者96例,按照随机数字表法分为观察组和对照组,各48例。在常规治疗的基础上,观察组患者给予小潮气量机械通气治疗,对照组患者给予常规潮气量机械通气治疗,比较两组相关血气分析指标、机械通气时间、气压伤发生情况及预后情况。结果通气前,两组相关血气分析指标比较,差异无统计学意义（P〉0.05）;通气后24 h,两组pH、氧分压（PaO2）明显比通气前高,二氧化碳分压（PaCO2）明显比通气前低,差异有高度统计学意义（P〈0.01）;通气后24 h,两组pH比较,差异无统计学意义（P〉0.05）;通气后24 h,观察组PaCO2、PaO2明显比对照组高,差异有高度统计学意义（P〈0.01）。观察组机械通气时间短于对照组,差异有高度统计学意义（P〈0.01）。观察组气压伤发生率低于对照组,差异有统计学意义（P〈0.05）。两组预后情况比较,差异有统计学意义（P〈0.05）。结论小潮气量机械通气治疗肺结核合并呼吸衰竭可有效提高患者的动脉血PaO2,降低气压伤发生率和死亡率,值得临床应用。 Objective To investigate clinical effect of low tidal volume mechanical ventilation and conventional tidal volume mechanical ventilation in the treatment of pulmonary tuberculosis complicated with respiratory failure. Methods96 cases of patients with pulmonary tuberculosis complicated with respiratory failure in Beijing Chest Hospital Affiliated to Capital Medical University from January 2011 to April 2014 were selected. And the patients were divided into observation group and control group according to the random number table method, each group of 48 cases. On the basis of conventional therapy, observation group was treated with low tidal volume mechanical ventilation, and control group was treated with conventional tidal volume mechanical ventilation. Relative indexes of blood gas analysis, time of mechanical ventilation, barotraumas and prognosis between two groups were compared. Results There were no statistical differences between two groups on relative indexes of blood gas analysis before ventilation（P〉 0.05）. After ventilation of 24 h, pH and PaO2 of two groups were obviously higher than those before ventilation, PaCO2 of two groups were obviously lower than those before ventilation, the differences were statistically significant（P 〉0.01）. After ventilation of 24 h, pH between two groups was compared, with no statistical difference（P〈0.05）. After ventilation of 24 h, PaCO2 and PaO2 of observation group were obviously higher than those of control group, the differences were statistically significant（P〈0.01）. Time of mechanical ventilation in observation group was shorter than that in control group, the difference was statistically significant（P〈0.01）. Barotrauma incidence rate of observation group was lower than that of control group, with statistical difference（P〈0.05）. Prognosis between two groups was compared, with statistical difference（P〈0.05）. Conclusion Low tidal volume mechanical ventilation in the treatment of pulmonary tuberculosis complicated with respira