许熙熙

[摘要] 目的 观察有创-无创序贯机械通气治疗重症肺炎疗效及对肺泡氧合功能、血清炎症因子水平的影响。 方法 对我院62例重症肺炎患者临床资料进行回顾性分析，根据其通气治疗方式差异分为有创-无创序贯机械通气治疗组（研究组，n=36）和有创通气治疗组（对照组，n=26）。观察两组治疗情况[有创通气时间、呼吸机相关性肺炎（VAP）发生率、ICU住院时间、病死率]，记录治疗前（T1）、治疗7 d后（T2）两组患者肺氧合指数（OI）、动脉血气分析指标[氧分压（PaO2）、氧饱和度（SaO2）]及血清炎症因子[肿瘤坏死因子-α（TNF-α）、白介素-1（IL-1）、IL-6]水平检测结果。 结果 研究组有创通气时间、VAP发生率、ICU住院时间、病死率均小于对照组（P<0.05）。T2时，两组OI、PaO2、SaO2均较T1时升高，且研究组高于对照组（P均<0.05）；血清TNF-α、IL-1、IL-6水平均较T1时降低，且研究组低于对照组（P均<0.05）。 结论 有创-无创序贯机械通气治疗重症肺炎疗效确切，对改善患者肺氧合功能、减轻炎症反应有一定帮助，于促进患者疾病恢复有利。

[关键词] 有创-无创序贯机械通气；重癥肺炎；氧合功能；血气分析；炎症

[中图分类号] R563.1 [文献标识码] A [文章编号] 1673-9701（2018）23-0012-03

The effect of invasive non-invasive sequential mechanical ventilation in severe pneumonia and its effect on alveolar oxygenation and serum inflammatory factors

XU Xixi

Department of Intensive Care Unit， the Fourth People's Hospital of Shenyang， Shenyang 110034， China

[Abstract] Objective To observe the effect of invasive non-invasive sequential mechanical ventilation in the treatment of severe pneumonia and its effect on alveolar oxygenation and serum inflammatory factors. Methods The clinical data of 62 patients with severe pneumonia in our hospital were retrospectively analyzed. According to the difference in ventilation therapy， they were divided into invasive non-invasive sequential mechanical ventilation group（study group， n=36） and invasive ventilation group（control group， n=26）. The treatment status of the two groups[invasive ventilation time， ventilator-associated pneumonia（VAP） incidence， length of ICU stay， mortality rate]was observed. The pulmonary oxygenation index（OI）， arterial blood gas analysis parameters（PaO2， SaO2）， serum inflammatory factors （TNF-α， IL-1， IL-6） test results in two groups before treatment（T1） and at 7 days after treatment（T2） were recorded. Results The duration of invasive ventilation， the incidence of VAP， the duration of ICU stay， and the mortality of the study group were all less than those of the control group（P<0.05）. At T2， the OI， PaO2， and SaO2 levels in both groups were higher than those at T1， and the OI， PaO2， and SaO2 in the study group were higher than those in the control group（P<0.05）. Serum TNF-α， IL-1， and IL-6 levels at T2 were lower than those at T1. And the serum TNF-α， IL-1， and IL-6 levels in the study group were lower than those in the control group（P all<0.05）. Conclusion Invasive non-invasive sequential mechanical ventilation is effective in the treatment of severe pneumonia， which is helpful to improve lung oxygen and function and reduce inflammation in patients， and is beneficial to promote the recovery of patients' disease.

[Key words] Invasive non-invasive sequential mechanical ventilation； Severe pneumonia； Oxygenation function； Blood gas analysis； Inflammation

文献显示，感染导致的死亡人口约占世界病死人口的1/3，而以肺部感染为主的呼吸道感染致死率位居各感染性疾病首位，约90%以上的患者为社区获得性肺炎（community acquired pneumonia，CAP）[1]。重症肺炎患者需予以呼吸支持，常规通气方法为有创通气，通气时间较长，易引起呼吸机相关性肺炎（ventilator associated pneumonia，VAP）、呼吸机依赖、脱机拔管困难等不良情况，对患者恢复不利[2]。有创-无创序贯机械通气可显著缩短有创通气时间，可能对改善上述情况有一定帮助[3]。对此，本研究观察有创-无创序贯机械通气在重症肺炎中的应用情况，现报道如下。

1 资料与方法

1.1 一般资料

对2016年1月～2018年1月沈阳市第四人民医院重症医学科62例重症肺炎患者临床资料进行回顾性分析。……