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目的研究无创机械通气(NPPV)治疗重症肺炎合并急性呼吸衰竭(SP-ARF)的临床疗效。方法 60例重症肺炎合并急性呼吸衰竭患者在征得患者家属同意的前提下随机分为两组,所有患者均在常规治疗的前提下,观察组应用NPPV治疗,对照组给予鼻导管吸氧,观察对比两组患者治疗前后血气分析和临床症状、体征等指标。结果两组患者治疗前血气分析指标pH、PaO2、PaCO2指标差异均无统计学意义(P>0.05);经过治疗之后,两组患者上述指标均显著下降,差异均有统计学意义(P<0.05);观察组治疗之后上述指标均显著低于对照组,差异有统计学意义(P<0.05)。观察组因病情恶化改有创机械通气3例(10.00%),对照组改有创机械通气14例(46.67%),两组差异有统计学意义(P<0.05);观察组平均住院时间(12.57±5.30)d,显著少于对照组(21.48±6.30)d,差异有统计学意义(P<0.05);因患者出现病情恶化改有创机械通气,观察组抢救无效死亡1例(3.33%),对照组3例(3.33%),两组差异无统计学意义(P>0.05)。结论 NPPV在临床应用效果满意,临床效果优于单纯应用鼻导管吸氧的方式,在有条件的医院应推广应用,但在应用过程中,在发现无创正压通气控制病情困难时,应尽早行有创正压机械通气(IPPV)治疗。
Objective To study the clinical efficacy of noninvasive mechanical ventilation (NPPV) in the treatment of severe pneumonia complicated with acute respiratory failure (SP-ARF). Methods Sixty patients with severe pneumonia complicated with acute respiratory failure were randomly divided into two groups with the consent of their families. All patients were treated with NPPV under the conventional treatment, while those in the control group were given nasal oxygenation and observation. Blood gas analysis and clinical symptoms, signs and other indicators before and after treatment were compared between two groups of patients. Results Before treatment, there was no significant difference of pH, PaO2 and PaCO2 between two groups (P> 0.05). After treatment, the above indexes of both groups were significantly decreased (P <0.05 ); The observation group after treatment the above indicators were significantly lower than the control group, the difference was statistically significant (P <0.05). In the observation group, invasive mechanical ventilation was changed in 3 cases (10.00%) due to the exacerbation of the disease and in 14 cases (46.67%) in the control group. The difference between the two groups was statistically significant (P <0.05) 12.57 ± 5.30) d, which was significantly lower than that of the control group (21.48 ± 6.30) d (P <0.05). One patient (3.33% ) And 3 cases (3.33%) in the control group. There was no significant difference between the two groups (P> 0.05). Conclusions NPPV is satisfactory in clinical application and its clinical effect is superior to that of simple nasal catheter oxygen inhalation. It should be popularized and applied in qualified hospitals. However, NPPV should be applied as soon as possible when it is found that noninvasive positive pressure ventilation is difficult to control Invasive positive pressure mechanical ventilation (IPPV) treatment.