论文部分内容阅读
目的:比较保守氧疗和常规氧疗对重症肺炎机械通气支持患者疗效的差异，并观察不同氧疗模式对患者预后的影响。方法:采用前瞻性随机对照研究方法，选择2019年5月至2021年5月入住合肥市第一人民医院重症监护病房（ICU）需要机械通气支持的110例重症肺炎患者，按随机数字表法将患者分为常规氧疗组（51例）和保守氧疗组（55例）。两组患者均采用有创-无创序贯通气策略，常规氧疗组氧疗目标设置为动脉血氧分压〔PaOn 2>150 mmHg（1 mmHg＝0.133 kPa）〕或脉搏血氧饱和度（SpOn 2）>0.96。保守氧疗组设置PaOn 2在70~100 mmHg或SpOn 2在0.90~0.92。观察两组患者治疗前后血气分析指标、机械通气时间、ICU住院时间、ICU病死率和入院后超过48 h新发器官功能障碍及感染发生率变化；采用Kaplan-Meier法分析两组累积生存率的差异。n 结果:两组治疗后pH值、PaOn 2、氧合指数（PaOn 2/FiOn 2）均较治疗前明显升高，动脉血二化碳氧分压（PaCOn 2）较治疗前明显降低，且治疗后保守氧疗组pH值明显高于常规氧疗组（7.4±0.1比7.3±0.3），PaOn 2、PaCOn 2、PaOn 2/FiOn 2均明显低于常规氧疗组〔PaOn 2（mmHg）：68.9±4.7比75.2±6.0，PaCOn 2（mmHg）：42.1±5.6比50.5±7.5，PaOn 2/FiOn 2（mmHg）：329±126比365±108〕，差异均有统计学意义（均n P 0.96. In the conservative oxygen therapy group, PaO n 2 was set at 70-100 mmHg or SpOn 2 at 0.90-0.92. The changes of blood gas analysis, mechanical ventilation time, ICU stay time, ICU mortality, new organ dysfunction and infection more than 48 hours after admission were observed in two groups before and after treatment. Kaplan-Meier method was used to analyze the difference in cumulative survival rate between the two groups.n Results:After treatment, pH value, PaOn 2 and oxygenation index (PaOn 2/FiOn 2) in both groups were significantly higher than before treatment, and arterial partial pressure of carbon dioxide (PaCOn 2) was significantly lower than before treatment. pH value in the conservative oxygen therapy group was significantly higher than that in the conventional oxygen therapy group (7.4±0.1 vs. 7.3±0.3). PaOn 2, PaCOn 2 and PaOn 2/FiOn 2 were significantly lower than those in conventional oxygen therapy group [PaOn 2 (mmHg): 68.9±4.7 vs. 75.2±6.0, PaCOn 2 (mmHg): 42.1±5.6 vs. 50.5±7.5, PaOn 2/FiOn 2 (mmHg): 329±126 vs. 365±108, all n P < 0.05]. The mechanical ventilation time in the conservative oxygen therapy group was significantly longer than that in the conventional oxygen therapy group (days: 19.7±3.5 vs. 13.9±4.5, n P 0.05). Compared with the conventional oxygen therapy group, the ICU mortality, the incidence of nosocomial bloodstream infection, and the incidence of liver insufficiency, shock, and ICU acquired weakness (ICUAW) were decreased significantly in the conservative oxygen therapy group [ICU mortality: 27.3% (15/55) vs. 45.1% (23/51), liver insufficiency: 1.8% (1/55) vs. 7.8% (4/51), shock: 3.6% (2/55) vs. 9.8% (5/51), ICUAW: 5.5% (3/55) vs. 11.8% (6/51), the incidence of new bloodstream infection: 5.5% (3/55) vs. 11.8% (6/51), all n P < 0.05]. Kaplan-Meier analysis showed that the cumulative survival rate of the conservative oxygen therapy group was significantly higher than that of the conventional oxygen therapy group (72.7% vs. 54.9%; Log-Rank test: χ n 2 = 4.244, n P = 0.039).n Conclusion:Conservative oxygen therapy can reduce ICU mortality, the incidence of shock, liver insufficiency, ICUAW, and bloodstream infection in patients with severe pneumonia, but prolong mechanical ventilation time.