呼吸机肺保护性通气与序贯通气治疗老年重症肺炎合并呼吸衰竭的疗效比较

目的探讨呼吸机肺保护性通气与序贯通气治疗老年重症肺炎合并呼吸衰竭的效果。方法选择2012年6月至2013年12月在郑州市第九人民医院重症监护室治疗的92例老年重症肺炎合并呼吸衰竭患者为研究对象,采用随机数字表法将患者分为序贯性机械通气组和肺保护性通气组,每组46例。序贯性机械通气组予以有创与无创序贯性机械通气,肺保护性通气组予以呼吸机肺保护性通气。比较两组患者治疗前及治疗7 d时的血气指标(pH、PaO2、PaCO2)、呼吸频率及心率的水平,两组患者有创通气时间、机械通气总时间以及1周内再插管率、呼吸机相关性肺损伤(VILI)发生率及病死率。结果治疗前,两组患者pH、PaO2、PaCO2、呼吸频率及心率比较,差异均无统计学意义(P>0.05)。治疗后,两组患者的pH、PaO2较治疗前显著升高(P<0.05),PaCO2、呼吸频率及心率显著降低(P<0.05);序贯性机械通气组有创通气时间少于肺保护性通气组(t=6.09,P<0.01)、而肺保护性通气组PaCO2高于序贯性机械通气组(t=3.50,P<0.05),其他指标以及机械通气总时间、再插管率、VILI发生率及病死率比较,差异均无统计学意义(P>0.05)。结论呼吸机肺保护性通气与序贯通气均能有效治疗老年重症肺炎合并呼吸衰竭,其中呼吸机肺保护性通气具有低潮气量、允许性高碳酸血症的特点,而序贯通气则能减少有创通气时间,临床医师可根据患者实际情况选择治疗方法。

Clinical Effect Comparison of Lung Protective Ventilation and Sequential Ventilation on Treating Elderly Severe Pneumonia Patients with Respiratory Failure

Objective To explorer the effect of lung protective ventilation and sequential ventilation on treating elderly severe pneumonia patients with respiratory failure. Methods Total of 92 elderly patients with severe pneumonia and respiratory failure in intensive care unit of Zhengzhou City Ninth People＇s Hospital from Jun. 2012 to Dec. 2013 were selected, and randomly divided into sequential mechanical ventilation group and lung protective ventilation group according to random number table method ,46 patients per group. Patients in sequential mechanical ventilation group were treated by sequential invasive or non-invasive mechanical ventilation, and patients in lung protective ventilation group were given lung protective ventila- tion. Blood gas index（ pH ,PaO2 ,PaCO2 ） ,breathing frequency and heart rate of two groups before and 7 days after treatment were compared, invasive ventilation time, mechanical ventilation time and reintubation rate within 1 week, ventilator-induced lung injury（VILI） incidence and mortality were compared too. Results Before treatment, there was no statistical difference between the two groups on pH, PaO2, PaCO2 , breathing frequency and heart rate（ P 〉 0.05 ）. After treatment, two groups＇pH and PaO2 were significantly increased （ P 〈 0.05 ）, PaCO2, breathing frequency and heart rate were significant decreased （ P 〈 0.05 ）. Sequential mechanical ventilation group＇s invasive ventilation time was less than that of lung protective ventilation group （t =6.09,P 〈0.01 ） and PaCO2 was lower than sequential mechanical ventilation group（t =3.50,P 〈 0.05） ,there was no statistical difference between the two groups on other blood gas indexes and the total time of mechanical ventilation, reintubation rate, VILI incidence and mortality after treatment （ P 〉 0.05 ）. Conclusion Both lung protective ventilation and sequential ventilation can effectively treat elderly severe pneumonia patients with respiratory failure, lung protective ventilation has features