论文部分内容阅读
[目的]探讨无创通气早期介入联合镇静镇痛和纤维支气管镜(纤支镜)吸痰治疗在地震伤急性呼吸窘迫综合征(ARDS)患者的应用价值。[方法]对四川大学华西医院ICU在玉树地震中救治的ARDS无创通气患者(A组)和汶川地震中的ARDS无创通气患者(B组)临床资料进行双向性队列研究。A组患者采用无创通气早期介入联合镇静镇痛和纤支镜吸痰治疗,B组患者采用传统无创通气治疗方法。观察A组患者无创通气治疗前及治疗后1 h、24 h、48 h,氧合指数(OI)、呼吸频率和心率的变化情况,最终比较A、B两组患者的气管插管率和肺部感染的发生率,机械通气时间和住ICU时间,ICU死亡率。[结果]共收治地震伤ARDS无创通气患者19例,A组6例,B组13例。A组患者无创通气治疗后1 h、24 h、48 h,氧合指数(OI)、呼吸频率和心率均明显改善,气管插管率和肺部感染率均为0,明显较B组低,其住ICU时间较B组短,差异有统计学意义,A、B两组患者均好转。[结论无创通气早期介入联合镇静镇痛和纤支镜吸痰治疗ARDS患者,可有效缓解临床症状,提高无创通气治疗的成功率,减少患者的气管插管率和肺部感染发生率。
[Objective] To explore the application value of early interventional non-invasive ventilation combined with sedation analgesia and bronchoscopy (bronchoscopy) suction sputum in patients with earthquake-induced acute respiratory distress syndrome (ARDS). [Methods] A bi-directional cohort study was conducted on the clinical data of ARDS noninvasive ventilation patients (ICU) treated by West China Hospital of West China Hospital of West China Hospital of Huaxi Hospital in Sichuan Province and non-invasive ventilation of ARDS patients in Wenchuan Earthquake (Group B). A group of patients with noninvasive ventilation early interventional combined sedation analgesia and bronchoscopy suction treatment, B group of patients with conventional non-invasive ventilation treatment. The changes of oxygenation index (OI), respiratory rate and heart rate before and after 1 h, 24 h, 48 h after noninvasive ventilation were observed in group A, and finally the tracheal intubation rates and lungs of patients in groups A and B were compared The incidence of infection, duration of mechanical ventilation and ICU stay, ICU mortality. [Results] Nineteen patients with ARDS were enrolled in this study. Six patients in group A and 13 in group B received ARV. The oxygenation index (OI), respiratory rate and heart rate in group A were significantly improved at 1 h, 24 h and 48 h after tracheal intubation. The rate of tracheal intubation and pulmonary infection was 0, significantly lower than that of group B, The living time of ICU was shorter than that of group B, the difference was statistically significant. Patients in group A and B both improved. [Conclusion Noninvasive ventilation early interventional combined with sedation analgesia and bronchoscopy suction treatment of ARDS patients can effectively relieve clinical symptoms, improve the success rate of noninvasive ventilation and reduce the incidence of tracheal intubation and pulmonary infection.