无创正压通气序贯治疗时机选择方案差异对重症CAP合并呼吸衰竭患者有创通气时间及预后的影响

摘要

目的：探讨以肺部感染控制窗和自主呼吸试验进行无创正压通气序贯治疗时机选择对重症社区获得性肺炎( CAP)合并呼吸衰竭患者有创通气时间及预后的影响。方法研究对象选取我院2013年5月至2014年11月收治重症CAP合并呼吸衰竭患者共220例，采用抽签法分为A组(110例)和B组(110例)，分别采用肺部感染控制窗和自主呼吸试验确定无创正压通气序贯治疗时机；比较两组患者有创通气时间、总机械通气时间、ICU时间、再次插管率、死亡率及呼吸机相关性肺炎发生率。结果 B组患者有创通气时间、总机械通气时间及ICU时间均明显短于A组，差异具有显著性( P<0．05)；B组患者再次插管率明显低于A组，差异具有显著性(P<0．05)；两组患者死亡率比较差异无显著性(P>0．05)；B组患者呼吸机相关性肺炎发生率明显低于A组，差异具有显著性(P<0．05)。结论相较于肺部感染控制窗，自主呼吸试验用于重症CAP合并呼吸衰竭患者行无创正压通气序贯治疗时机确定可显著缩短有创及总机械通气时间，加快病情康复进程，并有助于降低再次插管和呼吸机相关性肺炎发生风险。%Objective To investigate the influence of two kinds of timing selection methods of noninvasive positive pressure ventilation for sequential therapy on invasive ventilation time and prognosis of patients with severe community acquired pneumonia ( CAP) complicated with respiratory failure including pulmonary infection control win-dow and independent breathing test. Methods 220 patients with severe CAP complicated with respiratory failure were chosen from May 2013 to May 2014 in our hospital and randomly divided into the group A (110 patients) with pulmonary infection control window and the group B (110 patients) with independent breathing test in order to select the timing of noninvasive positive pressure ventilation for sequential therapy. Their invasive ventilation time, total me-chanical ventilation time, ICU time, re-intubation rate, mortality and the incidence of ventilator associated pneumonia were compared between the two groups. Results The invasive ventilation time, total mechanical ventilation time and ICU time were significantly shorter in the group B than in the group A (P<0. 05). The re-intubation rate was signifi-cantly lower in the group B than in the group A (P<0. 05). There was no significant difference in mortality between the two groups (P>0. 05). The incidence of ventilator associated pneumonia was significantly lower in the group B than in the group A ( P <0. 05 ) . Conclusion Compared with pulmonary infection control window, independent breathing test as timing selection methods of noninvasive positive pressure ventilation for sequential therapy on patients with severe CAP complicated with respiratory can efficiently shorten the invasive ventilation time and total mechanical ventilation, speed up the rehabilitation process, and be helpful to reduce the risk of re-intubation and ventilator asso-ciated pneumonia.