序贯机械通气治疗改善重症肺炎合并呼吸衰竭患者肺泡氧合功能、全身炎症反应综合征的研究

摘要

[ABSTRACT]Objective:To study the effect of sequential mechanical ventilation therapy on alveolar oxygenation function and systemic inflammatory response syndrome in patients with severe pneumonia and respiratory failure.Methods:A total of 92 patients who were diagnosed with severe pneumonia and required mechanical ventilation therapy in our hospital from May 2012 to October 2015 were selected and randomly divided into two groups,sequential group received invasive-non-invasive sequential mechanical ventilation therapy and routine group received conventional invasive mechanical ventilation therapy.Three days after treatment,blood gas analysis parameters,mechanical ventilation parameters,the levels of inflammatory cytokines,cardiac function inj ury molecules,kidney damage molecules in serum and the levels of kidney damage molecules in the urine were com-pared between two groups of patients.ResuIts:Three days after treatment,PaO2 ,HCO3 -,TI,TE and TPTEF of sequential group were significantly higher than those of routine group;serum IL-6,TNF-α,sTREM-1,IL-4,IL-10,IL-13,ANP,BNP, NPY,cTnI,CYS,NGAL and KIM-1 levels of sequential group were significantly lower than those of routine group,and urine NGAL,KIM-1 and Netrin-1 levels were significantly lower than those of routine group.ConcIusions:Invasive-non-invasive se-quential mechanical ventilation therapy can improve the alveolar oxygenation function and reduce the systemic inflammatory re-sponse as well as cardiac function and renal function inj ury in patients with severe pneumonia and respiratory failure.%目的：：研究序贯机械通气治疗对重症肺炎合并呼吸衰竭患者肺泡氧合功能、全身炎症反应综合征的影响.方法：选择2012年5月~2015年10月在我院确诊为重症肺炎且需要接受机械通气治疗的92例患者，随机分为两组，序贯组接受有创-无创序贯机械通气治疗，常规组接受常规有创机械通气治疗.治疗后3d时，比较两组血气分析参数、机械通气参数以及血清中炎性因子、心功能损伤分子、肾功能损伤分子含量和尿液中肾功能损伤分子含量.结果：治疗后3 d 时，序贯组动脉血氧分压(PaO2)、碳酸氢根(HCO3-)、吸气时间(TI)、呼吸时间(TE)、达到呼吸峰流速的时间(TPTEF)显著高于常规组(P＜0．05)；序贯组血清中白介素(IL)-6、肿瘤坏死因子-α(TNF-α)、可溶性髓系细胞触发受体-1(sTREM-1)、IL-4、IL-10、IL-13、心钠肽(ANP)、脑钠肽(BNP)、神经肽 Y(NPY)、肌钙蛋白 I(cTnI)、半胱氨酸蛋白酶抑制剂(CYS)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)的含量显著低于常规组(P＜0．05)，尿液中 NGAL、KIM-1、Netrin-1的含量显著低于常规组(P＜0．05).结论：有创-无创序贯机械通气治疗能够改善重症肺炎合并呼吸衰竭患者的肺泡氧合功能、减轻全身炎症反应及心功能、肾功能的损伤.