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阶梯化气道管理策略对重症超高龄患者医院获得性肺炎的影响

Impact of Airway Stepwise Management Strategy on Hospital Acquired Pneumonia in the Ultra Elderly Critically Ill Patients

    摘要
  • 摘要:
    目的 探究阶梯化气道管理策略在重症超高龄医院获得性肺炎(hospital acquired pneumonia, HAP)患者救治中的应用价值。
    方法 回顾性收集2021年1月—2023年4月北京协和医院重症医学科超高龄(年龄≥80岁)HAP患者的临床资料，根据气道管理方式，将入组患者分为观察组(2022年1月—2023年4月)和对照组(2021年1月—12月)。其中对照组采用常规气道管理，观察组采用由简单到复杂、由无创到有创的阶梯化气道管理策略。比较两组患者气道干预前后氧合指标、气管插管/切开率及有创呼吸机使用率。
    结果 共入选符合纳入与排除标准的重症超高龄HAP患者61例，其中观察组31例、对照组30例，两组基线资料无统计学差异(P均＞0.05)。与气道干预前相比，两组患者干预12 h、48 h及72 h时动脉血二氧化碳分压均逐渐降低，动脉血氧分压、氧合指数均逐渐升高，各时间点比较差异均具有统计学意义(P均＜0.05)。相较于对照组，观察组干预后不同时间点动脉血二氧化碳分压均更低，动脉血氧分压、氧合指数均更高(P均＜0.05)；且观察组气道干预48 h时气管插管/切开率(35.5%比66.7%，P=0.015)、有创呼吸机使用率(41.9%比73.3%，P=0.013)均更低。
    结论 重症超高龄HAP患者应用阶梯化气道管理策略可显著改善氧合状况，并减少医源性创伤。

     

    Abstract:
    Objective To explore the impact of an airway stepwise management strategy in the treatment of hospital acquired pneumonia (HAP) in the ultra elderly critically ill patients.
    Methods Clinical data on the ultra eldely(≥80 years old) HAP patients at the department of Critied Care Medicine, Peking Union Medical College Hospital from January 2021 to April 2023 was retrospective collected, and the enrolled patients were divided into an observation group (January 2022-April 2023) and control group (January 2021-December 2021) according to the airway stepwise management strategy. In the control group, conventional airway manage- ment was used, and in the observation group, an airway stepwise management strategy from simple to complex and from noninvasive to invasive was used. The oxygenation indices before and after airway interventiont, tracheal intubation/tracheostomy rate, and invasive ventilator usage rate was compared in both groups.
    Results A total of 61 HAP patients who met the inclusion and exclusion criteria were selected, including 31 in the observation group and 30 in the control group. Compared with before airway intervention, the arterial partial pressure of carbon dioxide gradually decreased, arterial partial pressure of oxygen and oxygenation index gradually increased at 12 h, 48 h and 72 h of airway intervention(all P < 0.05). Compared with the control group, the observation group had lower arterial partial pressure of carbon dioxide, and higher arterial partial pressure of oxygen and oxygenation index(all P < 0.05), and the rate of tracheal intubation/incision (35.5% vs. 66.7%, P=0.015) and the rate of invasive ventilator use (41.9% vs. 73.3%, P=0.013) were lower in the observation group at 48 h of airway intervention.
    Conclusions The application of an airway stepwise management strategy in the ultra elderly HAP patients can significantly improve oxygenation status and reduce iatrogenic trauma.

     

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