| 冷凌涵,陈 浩,宋佳平,宋家志,艾 娇.有创-无创序贯机械通气与传统有创机械通气治疗重症肺炎合并呼吸衰竭的疗效对比研究及院内死亡的危险因素分析[J].,2022,(23):4576-4580 |
| 有创-无创序贯机械通气与传统有创机械通气治疗重症肺炎合并呼吸衰竭的疗效对比研究及院内死亡的危险因素分析 |
| Comparative Study on the Efficacy of Invasive Non-Invasive Sequential Mechanical Ventilation and Traditional Invasive Mechanical Ventilation in the Treatment of Severe Pneumonia Complicated with Respiratory Failure and Analysis of Risk Factors for In-Hospital Death |
| 投稿时间：2022-04-07 修订日期：2022-04-30 |
| DOI：10.13241/j.cnki.pmb.2022.23.035 |
| 中文关键词: 有创-无创序贯机械通气 有创机械通气 重症肺炎 呼吸衰竭 院内死亡 危险因素 |
| 英文关键词: Invasive non-invasive sequential mechanical ventilation Invasive mechanical ventilation Severe pneumonia Respiratory failure In-hospital death Risk factors |
| 基金项目:四川省医学会专项基金（2015ZZ011） |
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| 中文摘要: |
| 摘要 目的：对比传统有创机械通气与有创-无创序贯机械通气治疗重症肺炎合并呼吸衰竭的疗效，并分析院内死亡的危险因素。方法：病例源于成都市第五人民医院2019年8月~2022年1月期间收治的重症肺炎合并呼吸衰竭患者120例，根据机械通气治疗方案不同将患者分为两组，常规组（n=60，传统有创机械通气）和序贯组（n=60，有创-无创序贯机械通气）。对比两组临床指标、血气分析指标、炎症因子指标、心功能指标。120例患者根据院内死亡情况分为死亡组（n=31）和存活组（n=89），统计死亡组和存活组的一般资料情况，多因素Logistic分析院内死亡的危险因素。结果：序贯组的重症监护室（ICU）住院时间、总住院时间、有创通气时间、机械通气总时间均短于常规组，院内死亡率低于常规组（P<0.05）。序贯组治疗后氧分压（PaO2）、pH值高于常规组，二氧化碳分压（PaCO2）低于常规组（P<0.05）。序贯组治疗后白介素-10（IL-10）高于常规组，肌钙蛋白Ｉ（cTnＩ）、Ｂ型氨基端利钠肽原（NT-proBNP）、可溶性髓系细胞触发受体-１（sTREM-1）、肿瘤坏死因子-α（TNF-α）低于常规组（P<0.05）。重症肺炎合并呼吸衰竭院内死亡与急性生理与慢性健康评分Ⅱ( APACHEⅡ评分) 、多重耐药菌感染、白蛋白（Alb）、合并基础疾病、多器官功能障碍评分（MODS评分）、年龄、肺炎严重程度评分（PSI）、红细胞比容（Hct）、社区获得性肺炎评分（CURB-65）、空腹血糖（FBG）有关（P<0.05）。合并基础疾病、存在多重耐药菌感染、高CURB-65评分、高PSI评分、高MODS评分、低Alb、高APACHEⅡ评分是重症肺炎合并呼吸衰竭院内死亡的危险因素（P<0.05）。结论：有创-无创序贯机械通气可缩短ICU住院时间、总住院时间、有创通气时间、机械通气总时间，降低院内死亡率，调节血气分析指标、心功能指标和炎症因子水平。重症肺炎合并呼吸衰竭患者院内死亡受到高MODS评分、低Alb、高PSI评分、合并基础疾病、高APACHEⅡ评分、存在多重耐药菌感染、高CURB-65评分等多种因素的影响。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the efficacy of traditional invasive mechanical ventilation and invasive non-invasive sequential mechanical ventilation in the treatment of severe pneumonia complicated with respiratory failure, and to analyze the risk factors of in-hospital death. Methods: The cases originated from 120 patients with severe pneumonia complicated with respiratory failure who were treated in Chengdu Fifth People's Hospital from August 2019 to January 2022. According to different mechanical ventilation treatment schemes, the enrolled patients were divided into two groups, the conventional group (n=60, traditional invasive mechanical ventilation) and the sequential group (n=60, invasive non-invasive sequential mechanical ventilation). The clinical indexes, blood gas analysis indexes, inflammatory factor indexes and cardiac function indexes were compared between the two groups. 120 patients were divided into death group (n=31) and survival group (n=89) according to the situation of in-hospital death. The general data of the death group and survival group were counted, and the risk factors of in-hospital death were analyzed multivariate logistic analysis. Results: The intensive care unit (ICU) hospitalization time, total hospitalization time, invasive ventilation time and total mechanical ventilation time in the sequential group were shorter than those in the conventional group, and the in-hospital mortality was lower than that in the conventional group (P<0.05). After treatment, the partial pressure of oxygen (PaO2) and pH value in the sequential group were higher than those in the conventional group, and the partial pressure of carbon dioxide (PaCO2) was lower than that in the conventional group (P<0.05). After treatment, the interleukin-10 (IL-10) in the sequential group was higher than that in the conventional group, troponin I (cTnI), type B amino terminal natriuretic peptide (NT-proBNP), soluble myeloid cell trigger receptor-1 (sTREM-1) and tumor necrosis factor-α (TNF-α) were lower than those in the conventional group (P<0.05). The in-hospital death of severe pneumonia complicated with respiratory failure was related to acute physiology and chronic health score II (APACHE II score), multi drug resistant bacteria infection, albumin (Alb), combined with basic diseases, multiple organ dysfunction score (MODS score), age, pneumonia severity index (PSI) score, hematocrit (Hct), community- acquired pneumonia score (CURB-65), fasting blood glucose (FBG) (P<0.05). The combined with basic diseases, the presence of multi drug resistant bacterial infection, high CURB-65 score, high PSI score, high MODS score, low Alb and high APACHEⅡ score were the risk factors for hospital death of severe pneumonia complicated with respiratory failure (P<0.05). Conclusion: Invasive non-invasive sequential mechanical ventilation can shorten ICU hospitalization time, total hospitalization time, invasive ventilation time and total mechanical ventilation time, reduce in-hospital mortality, and regulate blood gas analysis indexes,, cardiac function indexes, and inflammatory factor levels. The in-hospital death of patients with severe pneumonia complicated with respiratory failure are affected by many factors, such as high APACHEⅡ score, high MODS score, high CURB-65 score, high PSI score, combined with basic diseases, low Alb, and the presence of multi drug resistant bacterial infection. |
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