摘要
目的浅析重症加强护理病房(ICU)重症慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者应用无创序贯机械通气治疗的临床效果。方法78例ICU重症COPD合并呼吸衰竭患者,根据掷硬币法分为参照组及试验组,每组39例。参照组患者进行有创机械通气治疗,试验组患者进行无创序贯机械通气治疗。对比两组患者ICU入住时间、机械通气时间、呼吸机相关性肺炎发生情况及治疗前后动脉血气指标[动脉血酸碱度(pH)、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))]、血清炎症细胞因子[肿瘤坏死因子-α(TNF-α)、核因子-κB(NF-κB)、白细胞介素-6(IL-6)]表达水平。结果治疗4 h,试验组患者的pH、PaCO_(2)、PaO_(2)分别为(7.35±0.07)、(62.31±8.57)mm Hg(1 mm Hg=0.133 kPa)、(64.82±10.17)mm Hg,对照组患者分别为(7.29±0.05)、(73.31±11.26)mm Hg、(51.53±8.25)mm Hg;治疗36 h,试验组患者的pH、PaCO_(2)、PaO_(2)分别为(7.36±0.05)、(51.98±6.02)mm Hg、(72.61±11.08)mm Hg,对照组患者分别为(7.31±0.06)、(63.21±10.69)mm Hg、(56.17±9.22)mm Hg。试验组患者治疗4、36 h的pH和PaO_(2)明显高于参照组,PaCO_(2)明显低于参照组,统计学意义成立(P<0.05)。试验组患者ICU入住时间(12.15±1.68)d和机械通气时间(10.08±1.74)d均短于参照组的(20.63±3.27)、(19.82±2.53)d,统计学意义成立(P<0.05)。试验组患者呼吸机相关性肺炎发生率低于参照组,统计学意义成立(χ^(2)=3.924,P=0.048<0.05)。试验组患者治疗后3个月的TNF-α、NF-κB、IL-6水平分别为(2.08±0.57)pg/ml、(6.48±1.12)ng/ml、(10.62±2.39)pg/ml,明显低于参照组的(3.31±0.74)pg/ml、(9.49±1.34)ng/ml、(15.31±3.15)pg/ml,统计学意义成立(P<0.05)。结论ICU重症COPD合并呼吸衰竭患者进行无创序贯机械通气治疗,能够有效改善通气功能、减少并发症、缩短病程、减轻炎症反应,值得普及应用。
Objective To analyze the clinical effect of noninvasive sequential mechanical ventilation in patients with severe chronic obstructive pulmonary disease(COPD)complicated with respiratory failure in intensive care unit(ICU).Methods 78 ICU patients with severe COPD complicated with respiratory failure were divided into the reference group and the experimental group according to coin tossing method,with 39 cases in each group.The reference group underwent invasive mechanical ventilation,and the experimental group underwent noninvasive sequential mechanical ventilation.Both groups were compared in terms of duration of ICU stay,mechanical ventilation time,occurrence of ventilator-associated pneumonia,arterial blood gas index[pH,arterial partial pressure of carbon dioxide(PaCO_(2)),arterial partial pressure of oxygen(PaO_(2))],serum inflammatory cytokines[tumor necrosis factor-α(TNF-α),nuclear factor-κB(NF-κB),interleukin-6(IL-6)]expression levels.Results After 4 h of treatment,the pH,PaCO_(2)and PaO_(2)of the experimental group were(7.35±0.07),(62.31±8.57)mm Hg(1 mm Hg=0.133 kPa)and(64.82±10.17)mm Hg,and those in the reference group were(7.29±0.05),(73.31±11.26)mm Hg and(51.53±8.25)mm Hg.After 36 h of treatment,the pH,PaCO_(2)and PaO_(2)of the experimental group were(7.36±0.05),(51.98±6.02)mm Hg and(72.61±11.08)mm Hg,and those in the reference group were(7.31±0.06),(63.21±10.69)mm Hg and(56.17±9.22)mm Hg.The pH and PaO_(2)of the experimental group were significantly higher than those of the reference group after 4 and 36 h of treatment,while PaCO_(2)was significantly lower than that of the reference group,and the statistical significance was established(P<0.05).The duration of ICU stay of(12.15±1.68)d and mechanical ventilation time of(10.08±1.74)d in the experimental group were shorter than(20.63±3.27)and(19.82±2.53)d in the reference group,and the statistical significance was established(P<0.05).The incidence of ventilator-associated pneumonia in the experimental group was lower than the reference
作者
杜凯
DU Kai(Ningyang County First People's Hospital,Taian 271400,China)
出处
《中国实用医药》
2024年第3期41-44,共4页
China Practical Medicine
关键词
无创序贯机械通气
重症加强护理病房
重症慢性阻塞性肺疾病
呼吸衰竭
Noninvasive sequential mechanical ventilation
Intensive care unit
Severe chronic obstructive pulmonary disease
Respiratory failure
