摘要
目的 分析应用有创机械通气与无创机械通气治疗的心源性休克(CS)患者的临床特征与预后。 方法 纳入在我院心内科重症监护室(intensive care unit,ICU)住院治疗的386例CS患者。根据患者转入ICU 24 h内通气支持的方式不同,将患者分为3组:有创机械通气组(n=241)、无创机械通气组(n=52)与补氧组(n=93)。比较有创机械通气组与无创机械通气组患者的临床特征、治疗方法和预后。 结果 有创机械通气组更易发生谵妄[200(83.0%) vs. 16(30.8%),χ2=60.199,P<0.001],动脉血乳酸水平更高[3.9(2.4,7.1)mmol/L vs. 1.9(1.6,2.8)mmol/L,U=13.700,P<0.001],代谢性酸中毒更严重(HCO-3指标更低)[19.7(15.8,21.6)mmol/L vs. 22.1(20.6,24.1)mmol/L,U=3.134,P=0.002],提示接受有创机械通气治疗的患者存在较严重的组织低灌注和休克。无创机械通气组患者具有更高的N端前脑钠肽水平[7376.8(2054.6,17373.7)pg/mL vs. 2368.3(558.2,8564.7)pg/mL,U=2.261,P=0.023],提示接受无创机械通气治疗的患者可能存在心室扩张和充盈压增高。两组患者的90 d累计病死率比较差异无统计学意义(Log rank P=0.163)。多变量Logistic回归分析显示,患者90 d死亡的独立相关因素为:谵妄、冠状动脉搭桥手术、急性冠状动脉综合征、动脉血乳酸与动脉血二氧化碳分压(PaO2)(均P<0.05)。通气方式与患者90 d死亡无相关性(P=0.856)。 结论 CS患者可使用无创机械通气治疗呼吸衰竭,通气方式与患者预后无关。
Objective To analyze the clinical characteristics and prognosis of the patients with cardiogenic shock (CS) treated with invasive ventilation and non - invasive ventilation. Methods 386 CS patients admitted to ICU Department of Cardiology in our hospital were included. The patients were divided into three groups according to the different modes of ventilation in ICU after 24 h: invasive mechanical ventilation group ( n = 241 ), non - invasive mechanical ventilation group ( n = 52 ) and oxygen supplementation group ( n = 93 ). The clinical characteristics, treatment and prognosis of the patients treated with invasive ventilation and non - invasive ventilation were evaluated. Results The i nvasive ventilation group was more prone to delirium [ 200 (83.0%) vs. 16 (30.8%), X2 = 60. 199, P〈0.001], higher lactic acid in arterial blood[3.9 (2.4, 7.1) mmol/L vs. 1.9 (1.6, 2.8) mmol/L, U = 13. 700, P 〈 0. 001 ] and more severe metabolic acidosis ( lower HCO3- ) [ 19.7 ( 15.8, 21.6)mmol/L vs. 22.1 (20.6, 24.1) mmol/L, U=3. 134, P=0.002]. It suggests that there are serious tissue hypoperfusion and shock in patients receiving invasive mechanical ventilation. The patients in the non- invasive mechanical ventilation group had higher N - terminal prohormone of brain natriuretic peptide[ 7376.8 (2054.6, 17373.7) pg/mL vs. 2368.3 (558.2, 8564.7) pg/mL, U = 2. 261, P = 0. 023 ], suggesting that patients with non - invasive mechanical ventilation may have ventricular dilatation and increased filling pressure. There was no significant difference in cumulative 90 - day mortality between two groups ( Log rank P = 0. 163 ). Multivariate Logistic regression analysis showed that the independent factors associated with 90 - day mortality were delirium, coronary artery bypass grafting, acute coronary syndrome, arterial lactate and partial pressure of oxygen in arterial blood ( all P 〈 0.05). Ventilation was not associated with 90 - day mortality ( P = 0. 856). Conclusi
作者
李玉东
杨清泉
毛绍芬
张明磊
王星
张斐菲
Li Yu-dong;Yang Qing-quan;Mao Shao-fen;Zhang Ming-lei;Wang Xing;Zhan Fei-fei(First Special Ward,Nanyang City Central Hospital,Nanyang 473000,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2018年第11期964-969,共6页
Chinese Journal of Critical Care Medicine