本文選題：大面積腦梗死 + 老年�。� 參考：《福建醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：比較大面積腦梗死老年患者并發(fā)呼吸衰竭時機械通氣前后血氣變化，，探討血氣變化的機制，揭示血氣分析對老年患者大面積腦梗死臨床轉(zhuǎn)歸的價值，以期為大面積腦梗死出現(xiàn)酸堿平衡紊亂提供最佳的臨床治療依據(jù)。 方法：采用回顧性分析，以2010年—2013年入住福建醫(yī)科大學(xué)附屬協(xié)和醫(yī)院的40例大面積腦梗死老年患者為研究對象，入選病例均進行心電、血壓、脈搏、末梢血氧飽和度監(jiān)測，采集動脈血行血氣分析，記錄氣管插管呼吸機輔助通氣前后的動脈血氣分析及血氧飽和度監(jiān)測變化轉(zhuǎn)歸，采用GOS評分表對患者的預(yù)后進行評定，探討血氣分析變化與呼吸機輔助通氣與病情轉(zhuǎn)歸的關(guān)系。數(shù)據(jù)采用SPSS18.0統(tǒng)計軟件進行處理。 結(jié)果：根據(jù)GOS預(yù)后評分表，低氧血癥組（Pa0260mmHg）與動脈血氧分壓正常組相比差別有統(tǒng)計學(xué)意義（p＜0.05），提示低氧血癥影響大面積腦梗死患者的預(yù)后；血氣酸堿值正常組與酸堿值失衡組相比，預(yù)后差別有統(tǒng)計學(xué)意義(p0.05)，提示酸堿失衡影響患者預(yù)后；缺氧24小時內(nèi)與24小時后行氣管插管相比較，差異有統(tǒng)計學(xué)意義(P0.05)，提示氣管插管早晚與患者預(yù)后相關(guān)；氣管插管機械輔助通氣前后，動脈血氣指標(biāo)相比較差異具有統(tǒng)計學(xué)意義（p 0.05），氣管插管機械輔助械通氣明顯改善大面積腦梗死患者各項血氣指標(biāo)。 結(jié)論：低氧血癥、血氣酸堿值與大面積腦梗死老年患者預(yù)后關(guān)系密切；早期監(jiān)測血氣分析、進行氣管插管輔助機械通氣可改善患者血氣指標(biāo)從而改善患者預(yù)后。血氣分析在大面積腦梗死老年患者臨床治療及預(yù)后中的具有重要的應(yīng)用價值。
[Abstract]:Objective: to compare the changes of blood gas before and after mechanical ventilation in elderly patients with large area cerebral infarction complicated with respiratory failure, to explore the mechanism of blood gas change, and to reveal the value of blood gas analysis in the clinical outcome of large area cerebral infarction in elderly patients. In order to provide the best clinical treatment basis for the occurrence of acid-base balance disorder in large area cerebral infarction. Methods: a retrospective analysis was conducted on 40 elderly patients with large area cerebral infarction who were admitted to Xianghe Hospital of Fujian Medical University from 2010 to 2013. ECG, blood pressure, pulse and oxygen saturation of peripheral blood were monitored. Arterial blood was collected for blood gas analysis, arterial blood gas analysis and blood oxygen saturation monitoring were recorded before and after tracheal intubation ventilator assisted ventilation. The prognosis of the patients was evaluated by GOS score table. To explore the relationship between blood gas analysis and ventilator-assisted ventilation. The data were processed by SPSS 18.0 software. Results: according to the GOS prognosis scale, there was a significant difference between hypoxemia group and normal group (P < 0.05), suggesting that hypoxemia affects the prognosis of patients with large cerebral infarction. The difference of prognosis between the normal blood gas pH group and the pH imbalance group was statistically significant (p 0.05), which indicated that the acid-base imbalance affected the prognosis of the patients, and the tracheal intubation was performed within 24 hours of hypoxia and 24 hours after hypoxia. The difference was statistically significant (P 0.05), indicating that tracheal intubation was related to the prognosis of the patients in the morning and evening, and before and after mechanical ventilation with tracheal intubation, The difference of arterial blood gas index was statistically significant (p 0.05). Mechanical ventilation with tracheal intubation could improve the blood gas index in patients with large area cerebral infarction. Conclusion: hypoxemia, blood gas pH and prognosis of elderly patients with large area cerebral infarction are closely related to the prognosis, early monitoring of blood gas analysis and tracheal intubation assisted mechanical ventilation can improve the blood gas index and improve the prognosis of patients. Blood gas analysis plays an important role in the treatment and prognosis of elderly patients with large area cerebral infarction.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3

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