有创无创序贯通气对重症肺炎患者血气分析指标及炎症反应的影响

doi:10.3760/cma.j.issn.1007-1245.2024.10.012

摘要/Abstract

摘要：

目的　探讨有创无创序贯通气对重症肺炎患者血气分析指标及炎症反应的影响。方法　前瞻性选取2020年3月至2023年3月空军第九八六医院接收的96例重症肺炎患者，通过随机数字表法分为对照组与观察组，各48例。对照组予以有创机械通气治疗，其中男25例，女23例，年龄（55.36±5.21）岁，体质量指数（BMI）（23.64±1.51）kg/m²；观察组予以有创无创序贯通气治疗，其中男26例，女22例，年龄（55.42±5.25）岁，BMI（23.61±1.48）kg/m²。比较两组手术相关指标、治疗前后的血气分析、肺功能、炎症反应指标。统计学方法采用t检验、χ²检验。结果　治疗前，观察组与对照组在血气分析、肺功能、炎症反应方面比较差异均无统计学意义（均P>0.05）。观察组的氧疗时间（12.32±2.21）d、有创通气时间（5.22±1.03）d、住院时间（18.31±2.76）d，均短于对照组的（20.33±3.25）d、（13.49±2.68）d、（25.46±3.87）d，差异均有统计学意义（t=14.120、19.956、10.421，均P<0.001）。治疗2周后，观察组的动脉血氧分压、动脉血氧饱和度均高于对照组［（78.02±6.01）mmHg（1 mmHg=0.133 kPa）比（71.25±5.86）mmHg、（93.72±6.45）%比（89.52±6.33）%］，动脉血二氧化碳分压低于对照组［（43.55±4.42）mmHg比（48.89±4.68）mmHg］，差异均有统计学意义（t=5.588、3.220、5.747，均P<0.001）；观察组的静态肺顺应性（Cst）高于对照组［（71.66±6.35）kPa比（60.25±5.21）kPa］，肺泡内外液体指数（EVLWI）低于对照组［（5.39±1.02）ml/kg比（8.57±1.54）ml/kg］，差异均有统计学意义（t=9.624、11.927，均P<0.001）；观察组的白细胞计数（6.71±1.25）×10⁹/L、C反应蛋白（41.55±4.32）mg/L、降钙素原（2.01±0.52）μg/L，均低于对照组的（9.58±1.87）×10⁹/L、（54.59±6.69）mg/L、（2.59±0.68）μg/L，差异均有统计学意义（t=8.840、11.345、4.694，均P<0.001）；观察组并发症总发生率低于对照组［4.17%（2/48）比18.75%（9/48）］，差异有统计学意义（χ²=5.031，P=0.025）。结论　采用有创无创序贯通气方式对重症肺炎患者进行治疗，相较于单纯的有创机械通气，能有效缩短氧疗和住院时间，改善患者血气分析指标和肺功能，降低炎症反应，表明该治疗方式更有利于患者恢复。

关键词:

重症肺炎, 有创无创序贯通气, 血气分析, 炎症反应

Abstract:

Objective　To investigate the effects of invasive-noninvasive sequential mechanical ventilation on blood gas analysis and inflammatory response in patients with severe pneumonia. Methods　A total of 96 patients with severe pneumonia admitted to Air Force 986 Hospital from March 2020 to March 2023 were prospectively selected and were divided into a control group and an observation group by the random number table method, with 48 cases in each group. The control group was treated with invasive mechanical ventilation, including 25 males and 23 females, aged (55.36±5.21) years, with a body mass index (BMI) of (23.64±1.51) kg/m². The observation group was treated with invasive-noninvasive sequential mechanical ventilation, 26 males and 22 females, aged (55.42±5.25) years, with a BMI of (23.61±1.48) kg/m². The surgery-related indicators, blood gas analysis indicators, lung function, and inflammatory response were compared between the two groups. Statistical methods used were t test and χ² test. Results　Before treatment, there were no statistically significant differences between the observation group and the control group in terms of blood gas analysis, lung function, or inflammatory response (all P>0.05). The duration of oxygen therapy [(12.32±2.21) d], invasive ventilation time [(5.22±1.03) d], and hospital stay [(18.31±2.76) d] in the observation group were shorter than those in the control group [(20.33±3.25) d, (13.49±2.68) d, and (25.46±3.87) d], with statistically significant differences (t=14.120, 19.956, and 10.421, all P<0.001). After 2 weeks of treatment, the partial pressure of arterial blood oxygen and saturation of arterial blood oxygen in the observation group were higher than those in the control group [(78.02±6.01) mmHg (1 mmHg = 0.133 kPa) vs. (71.25±5.86) mmHg, (93.72±6.45)% vs. (89.52±6.33)%], but the partial pressure of arterial blood carbon dioxide was lower than that in the control group [(43.55±4.42) mmHg vs. (48.89±4.68) mmHg], with statistically significant differences (t=5.588, 3.220, and 5.747, all P<0.001). The static lung compliance (Cst) in the observation group was higher than that in the control group [(71.66±6.35) kPa vs. (60.25±5.21) kPa], but the extra vascular lung water index (EVLWI) was lower than that in the control group [(5.39±1.02) ml/kg vs. (8.57±1.54) ml/kg], with statistically significant differences (t=9.624 and 11.927, both P<0.001). The levels of white blood cell count [(6.71±1.25) ×10⁹/L], C-reactive protein (CRP) [(41.55±4.32) mg/L], and procalcitonin (PCT) [(2.01±0.52) μg/L] in the observation group were lower than those in the control group [(9.58±1.87) ×10⁹/L, (54.59±6.69) mg/L, and (2.59±0.68) μg/L], with statistically significant differences (t=8.840, 11.345, and 4.694, all P<0.001). The total complication rate of the observation group was lower than that of the control group [4.17% (2/48) vs. 18.75% (9/48)], with a statistically significant difference (χ²=5.031, P=0.025). Conclusion　The use of invasive-noninvasive sequential mechanical ventilation in the treatment of patients with severe pneumonia, compared to solely invasive mechanical ventilation, effectively shortens the duration of oxygen therapy and hospitalization, improves the blood gas analysis and lung function, and reduces the inflammatory response, indicating that this treatment method is more beneficial for patients' recovery.

Key words:

Severe pneumonia, Invasive-noninvasive sequential mechanical ventilation, Blood gas analysis, Inflammatory response

刘巧艳王娟王永兴徐永妮王萍肖林萍.

有创无创序贯通气对重症肺炎患者血气分析指标及炎症反应的影响 [J]. 国际医药卫生导报, 2024, 30(10): 1643-1647.

Liu Qiaoyan, Wang Juan, Wang Yongxing, Xu Yongni, Wang Ping, Xiao Linping.

Effects of invasive-noninvasive sequential mechanical ventilation on blood gas analysis and inflammatory response in patients with severe pneumonia [J]. International Medicine and Health Guidance News, 2024, 30(10): 1643-1647.

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