本文選題：呼氣末正壓 + 呼吸機(jī)相關(guān)性肺炎��； 參考：《中華醫(yī)院感染學(xué)雜志》2014年01期

【摘要】：目的觀察低水平呼氣末正壓(PEEP)在防治重癥中毒機(jī)械通氣呼吸機(jī)相關(guān)性肺炎中的作用。方法選取急診2010年10月-2013年4月各類重癥中毒機(jī)械通氣患者共46例,按數(shù)字隨機(jī)法分為兩組,治療組在機(jī)械通氣時(shí)加用5cm H2O呼氣末正壓機(jī)械通氣,對照組不加用呼氣末正壓,比較兩組患者呼吸機(jī)相關(guān)性肺炎發(fā)生率。結(jié)果治療組23例發(fā)生VAP3例,發(fā)生時(shí)間(5.80±1.56)d,機(jī)械通氣時(shí)間(5.30±3.64)d,對照組23例VAP發(fā)生6例,發(fā)生時(shí)間為(3.10±1.43)d,機(jī)械通氣時(shí)間為(8.40±4.58)d,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.01);治療組23例患者使用PEEP前平均動(dòng)脈壓(81±2.35)mm Hg、心率(66±1.24)/min、經(jīng)皮血氧飽和度(90±2.47)%、氧分壓(59±3.42)mm Hg、二氧化碳分壓(45±2.75)mm Hg,使用PEEP后分別為(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前后平均動(dòng)脈壓、心率無明顯差異,經(jīng)皮血氧飽和度、氧分壓、二氧化碳分壓,差異有統(tǒng)計(jì)學(xué)意義(P0.05);46例患者治愈43例,死亡3例,死因主要為高齡合并多臟器功能衰竭,平均使用呼吸機(jī)時(shí)間為(6.4±3.26)d,治愈出院患者住院時(shí)間為(9.32±3.21)d。結(jié)論低水平PEEP對防治重癥中毒患者呼吸機(jī)相關(guān)性肺炎有一定療效。
[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 鹵1.56 days, and the time of mechanical ventilation was 5.30 鹵3.64 days. In the control group, there were 6 cases of VAP in 23 cases. The time of occurrence was 3.10 鹵1.43 minutes, the time of mechanical ventilation was 8.40 鹵4.58 days, the difference between the two groups was statistically significant (P 0.01), the mean arterial pressure before PEEP was 81 鹵2.35)mm / h, the heart rate was 66 鹵1.24 / min, the percutaneous oxygen saturation was 90 鹵2.47 / min, the partial pressure of oxygen was 59 鹵3.42)mm / Hg, the partial pressure of CO _ 2 was 45 鹵2.75)mm / Hg in the treatment group, and the mean arterial pressure was 81 鹵1.24 / min, and the oxygen saturation was 90 鹵2.47 / min, the partial pressure of oxygen was 59 鹵3.42)mm / h, and the partial pressure of CO _ 2 was 45 鹵2.75)mm / g, respectively. After PEEP, the mean arterial pressure was 68 鹵2.31 times / min, 96 鹵2.14 times / min, and 37 鹵37 鹵3.17)mm / hg, respectively, and the mean arterial pressure before and after using PEEP was 37 鹵2.31.The mean arterial pressure before and after use of PEEP was 96 鹵2.14, and the mean arterial pressure before and after PEEP was 37 鹵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 鹵3.26 days, and the hospitalization time of cured patients was 9.32 鹵3.21 days. Conclusion low level PEEP is effective in the prevention and treatment of ventilator-associated pneumonia in patients with severe poisoning.
【作者單位】： 臨安市人民醫(yī)院急診科;
【基金】：臨安市科技局科研基金項(xiàng)目(2011084)
【分類號(hào)】：R563.1

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