低水平呼气末正压在防治重症中毒机械通气呼吸机相关性肺炎中的作用

发布时间：2018-05-12 05:43

本文选题：呼气末正压 + 呼吸机相关性肺炎　；参考：《中华医院感染学杂志》2014年01期

【摘要】：目的观察低水平呼气末正压(PEEP)在防治重症中毒机械通气呼吸机相关性肺炎中的作用。方法选取急诊2010年10月-2013年4月各类重症中毒机械通气患者共46例,按数字随机法分为两组,治疗组在机械通气时加用5cm H2O呼气末正压机械通气,对照组不加用呼气末正压,比较两组患者呼吸机相关性肺炎发生率。结果治疗组23例发生VAP3例,发生时间(5.80±1.56)d,机械通气时间(5.30±3.64)d,对照组23例VAP发生6例,发生时间为(3.10±1.43)d,机械通气时间为(8.40±4.58)d,两组比较差异有统计学意义(P0.01);治疗组23例患者使用PEEP前平均动脉压(81±2.35)mm Hg、心率(66±1.24)/min、经皮血氧饱和度(90±2.47)%、氧分压(59±3.42)mm Hg、二氧化碳分压(45±2.75)mm Hg,使用PEEP后分别为(80±2.51)mm Hg、(68±2.31)次/min、(96±2.14)%、(97±4.26)mm Hg、(37±3.17)mm Hg;使用PEEP前后平均动脉压、心率无明显差异,经皮血氧饱和度、氧分压、二氧化碳分压,差异有统计学意义(P0.05);46例患者治愈43例,死亡3例,死因主要为高龄合并多脏器功能衰竭,平均使用呼吸机时间为(6.4±3.26)d,治愈出院患者住院时间为(9.32±3.21)d。结论低水平PEEP对防治重症中毒患者呼吸机相关性肺炎有一定疗效。
[Abstract]:Objective to observe the effect of low level positive end-expiratory pressure (PEEP) in the prevention and treatment of severe poisoning mechanical ventilation ventilator-associated pneumonia. Methods from October 2010 to April 2013, 46 emergency patients with severe toxic mechanical ventilation were randomly divided into two groups: the treatment group was treated with 5cm H2O positive end-expiratory pressure, while the control group did not use the positive end-expiratory pressure. The incidence of ventilator-associated pneumonia was compared between the two groups. Results in the treatment group, 23 cases had VAP3, the time of occurrence was 5.80 卤1.56 days, and the time of mechanical ventilation was 5.30 卤3.64 days. In the control group, there were 6 cases of VAP in 23 cases. The time of occurrence was 3.10 卤1.43 minutes, the time of mechanical ventilation was 8.40 卤4.58 days, the difference between the two groups was statistically significant (P 0.01), the mean arterial pressure before PEEP was 81 卤2.35)mm / h, the heart rate was 66 卤1.24 / min, the percutaneous oxygen saturation was 90 卤2.47 / min, the partial pressure of oxygen was 59 卤3.42)mm / Hg, the partial pressure of CO _ 2 was 45 卤2.75)mm / Hg in the treatment group, and the mean arterial pressure was 81 卤1.24 / min, and the oxygen saturation was 90 卤2.47 / min, the partial pressure of oxygen was 59 卤3.42)mm / h, and the partial pressure of CO _ 2 was 45 卤2.75)mm / g, respectively. After PEEP, the mean arterial pressure was 68 卤2.31 times / min, 96 卤2.14 times / min, and 37 卤37 卤3.17)mm / hg, respectively, and the mean arterial pressure before and after using PEEP was 37 卤2.31.The mean arterial pressure before and after use of PEEP was 96 卤2.14, and the mean arterial pressure before and after PEEP was 37 卤3.17)mm, respectively. There was no significant difference in heart rate. The difference of transcutaneous oxygen saturation, partial pressure of oxygen and partial pressure of carbon dioxide was statistically significant. 43 cases were cured and 3 cases died. The main cause of death was old age with multiple organ failure. The average time of ventilator use was 6.4 卤3.26 days, and the hospitalization time of cured patients was 9.32 卤3.21 days. Conclusion low level PEEP is effective in the prevention and treatment of ventilator-associated pneumonia in patients with severe poisoning.
【作者单位】：临安市人民医院急诊科;
【基金】：临安市科技局科研基金项目(2011084)
【分类号】：R563.1

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