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Mechanical Ventilation Strategy in Pulmonary Fibrosis with Severe Respiratory Failure
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摘要:
目的 研究肺间质纤维化合并严重呼吸衰竭患者的机械通气策略。 方法 54例肺间质纤维化合并呼吸衰竭患者分为无创通气组(21例)和有创通气组(33例), 观察两组患者机械通气前后动脉血气的变化以及机械通气治疗期间出现的并发症, 计算两组患者死亡率及平均住院时间。 结果 两组患者接受机械通气治疗1 h后氧合均得到明显改善(P < 0.01)。无创通气组患者机械通气治疗期间并发症发生率为23.8%, 明显少于有创通气组的51.5%(P=0.043);无创通气组和有创通气组患者死亡率分别为90.5%和93.9%, 两组差异无统计学意义(P=0.636);无创通气组患者平均住院时间为(13.1±11.7)d, 明显少于有创通气组的(19.4±15.8)d(P=0.008)。 结论 对于肺间质纤维化合并严重呼吸衰竭患者, 无创正压通气和有创通气均难以改善预后, 但无创正压通气因并发症较少且住院时间短, 可尝试使用。 Abstract:Objective To study the strategy of mechanical ventilation in pulmonary fibrosis with severe respiratory failure. Methods Fifty-four pulmonary fibrosis patients with severe respiratory failure requiring ventilatory support were divided into noninvasive ventilation group (n=21) and invasive ventilation group (n=33). The patients in noninvasive ventilation group were treated with noninvasive bi-level positive airway pressure (BiPAP) ventilation, and the patients in invasive ventilation group underwent endotracheal intubation and mechanical ventilation. Arterial blood gas was detected before ventilation and after one hour of ventilatory support. The complications of mechanical ventilation, mortality rate, and length of hospital stay were recorded. Results Significant improvements in PaO2 after one hour of ventilatory support were noted in both groups(P < 0.01). The incidence rate of complications in noninvasive ventilation group was lower than that in invasive ventilation group (23.8% versus 51.5%, P=0.043). No significant difference was found in the mortality rate between these two groups (90.5% versus 93.9%, P=0.636). The hospital stay of noninvasive ventilation group was significantly shorter than that of invasive ventilation group (13.1±11.7 days versus 19.4±15.8 days, P=0.008). Conclusions Neither noninvasive ventilation nor invasive mechanical ventilation can remarkably improve the survival of pulmonary fibrosis patients with severe respiratory failure. However, noninvasive ventilation can be applied in selected patients due to its lower incidence of complication and shorter hospital stay. -
表 1 两组患者基本资料
组别 年龄(岁，x±s) 性别(男/女) 病因(特发性/继发性) APACHEⅡ(x±s) 无创通气组(n=21) 53.9±15.2 10/11 3/18 24.3±7.6 有创通气组(n=33) 56.3±17.2 12/21 4/29 25.5±6.4 APACHEⅡ:急性生理与慢性健康评分Ⅱ 
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表 2 两组患者机械通气前和机械通气1 h后的动脉血气结果(x ±s)
组别 pH PaO2(mm Hg) PaCO2(mm Hg) 通气前 通气1 h 通气前 通气1 h 通气前 通气1 h 无创通气组(n=21) 7.47±0.03 7.48±0.04 40.3±10.6 63.5±14.1* 25.4±6.7 24.3±7.5 有创通气组(n=33) 7.46±0.05 7.48±0.05 38.9±11.5 66.4±15.3* 24.6±7.3 22.1±5.8 t值 0.31 0.12 1.18 1.25 0.82 0.95 P值 0.758 0.905 0.243 0.217 0.416 0.347 1 mm Hg=0.133 kP；与同组机械通气前比较，*P＜0.01
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