无创正压通气在重症肺炎早期集束化治疗中的应用探讨

目的探讨在重症肺炎早期集束化治疗中应用无创正压通气的治疗价值。方法将呼吸内科重症监护病房（RICU）2008年11月至2012年12月间收治的55例重症肺炎早期患者随机分为对照组（n=25）和治疗组（n=30）。对照组采用吸氧、抗感染、化痰、纠正电解质酸碱失衡等常规治疗方法,治疗组在对照组基础上加用无创正压通气。比较两组患者在治疗前及治疗后6、24、48 h的APACHEII评分、氧合指数、心率、气管插管率等指标的差异。结果与治疗前比较,治疗后两组患者APACHEII评分、心率逐渐下降,氧合指数逐渐升高,自治疗后24 h起,差异均有统计学意义（P均〈0.05）;且治疗组3项指标均优于对照组（P均〈0.05）。治疗组气管插管率低于对照组,但差异无统计学意义（P〉0.05）。结论无创正压通气在重症肺炎早期集束化治疗中能有效改善氧合、提高患者生活质量,能否显著降低气管插管率,尚待大样本进一步观察。

Application of noninvasive positive pressure ventilation in the cluster treatment of early severe pneumonia

Objective The aim of this study was to investigate the value of non- invasive positive pressure ventilation in cluster treatment of early severe pneumonia. Methods Fifty-five patients with early severe pneumonia in intensive care unit of respiratory department were randomly divided into the control group（n=25）and treatment group（n=30）from November,2008 to December,2012. Conventional treatment methods such as oxygen,antiinfection,eliminating phlegm,correcting electrolyte acid-base imbalance were implemented in the control group,while noninvasive positive pressure ventilation plus conventional treatment were given to treatment group. APACHEII scores,oxygenation index,heart rate,endotracheal intubation rate were compared in two groups before treatment and6h,24h,48h after treatment. Results Compared with the indexes of patients before treament,the APACHEII score and heart rate decreased,oxygenation index increased significantly since 24h after treatment,and the indexes in treatment group were superior to those in control group（ all P 0.05）. Meanwhile,the rate of endotracheal intubation was lower than that in control group,but no statistically significant was found between two groups（P0.05）. Conclusions Noninvasive positive pressure ventilation can effectively improve oxygenation and decrease the rate of intratracheal intubation in the cluster treatment of early severe pneumonia. Whether it can significantly decrease the rate of endotracheal intubation remains to be further observed in large sample.