无创机械通气在胡蜂螫伤并急性呼吸窘迫综合征患者中的应用研究被引量：3

Application of noninvasive mechanical ventilation in patients with wasp sting and acute respiratory distress syndrome

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摘要目的观察胡蜂螯伤合并急性呼吸窘迫综合征(ARDS)患者无创机械通气的疗效,分析影响其治疗效果的有关因素,更好的指导临床选择机械通气的策略。方法回顾性分析2016年8月一2018年9月湖北省十堰市太和医院EICU收治蜂螯伤合并ARDS的患者病历资料。根据患者接受无创机械通气治疗后是否调整为有创机械通气将患者分为无创治疗失败组与治疗成功组,比较两组患者年龄、性别、蜂螫伤的针刺皮损数、急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、序贯器官功能衰竭评分(SOFA)、超敏C反应蛋白(hsCRP)、血清乳酸(Lac)、降钙素原(PCT)、氧和指数(PaO22/FiO2)结果等。结果共纳入31例患者,治疗失败组12例,治疗成功组19例。两组年龄、性别比较,差异均无统计学意义(P>0.05)。单因素分析显示,治疗失败组APACHE Ⅱ评分、SOFA评分、超敏C反应蛋白(hsCRP)、血清乳酸(Lac)、降钙素原(PCT)均高于治疗成功组。多因素Logistic回归分析显示PaO2/FiO2,<130、SOFA>9分是治疗失败的独立危险因素。结论无创机械通气对胡蜂螫伤合并ARDS患者有一定的应用价值,但对于蜂螫伤PaO2/FiO2,<130..SOFA>9分的患者优先考虑给予有创机械通气。 Objective To observe the eficacy of non-invasive mechanical ventilation in patients with wasp sting and acute respiratory distress syndrome(ARDS),to analyze the factors afeeting the therapeutic efct,and to better guide the clinical selection of mechanical ventilation.Methods A retrospective analysis of the medical records of patients with wasp stings and ARDS admitted to EICU,Taihe Hospital of Shiyan City,Hubei Prov ince from August 2016 to Septem-ber 2018.Patients were divided into non-invasive treatment failure group and treatment success group according to whether they were adjusted to invasive mechanical ventilation after non-invasive mechanical ventilation treatment.The age,sex,number of acupuneture lesions of bee stings,acute physiology and chronicity were compared between the two groups.Health Status Score System Ⅱ(APACHE Ⅱ)score,sequential organ failure score(SOF A),hypersensitive C-reactive protein(hsCRP).serum laclate(Lac),procaleitonin(PCT),oxygen and index(PaO2/FiO2)results,ete.Results A total of 31 patients were included,12 in the treatment failure group and 19 in the successful treatment group.There were no significant differences in age and gender between the two groups(P>0.05).Univariate analysis showed that APACHE Ⅱ score,SOFA score,high-sensitivity C-reactive protein(hsCRP),serum lactate(Lac),and procaleitonin(PCT)were higher in the treatment failure group than in the suecessful treatment group.Multivariate logistic regression analysis showed that PaO2/FiO2,<130 and SOF A>9 scores were independent risk factors for treatment failure.Conclusion Non-invasive mechanical ventilation has certain application value for patients with wasp sting and ARDS,but it is preferred to give invasive mechanical ventilation for patients with PaO2/FiO2 less than 130 and SOFA greater than 9 points.

作者郭辉钟燕李昌盛柴林段辉段斌梁鹏飞杨贤义方志成 GUO Hui;ZHONG Yan;LI Changsheng;CHAI Lin;DUAN Hui;DUAN Bin;LIANG Pengfei;YANG Xianyi;FANG Zhicheng(Department of Emergency,Shiyan Taihe Hospital(Hospital Afliated to Hubei University of Medicine,Shiyan 442000,Hubei,China)

机构地区十堰市太和医院(湖北医药学院附属医院)

出处《中国急救复苏与灾害医学杂志》 2020年第7期844-846,852,共4页 China Journal of Emergency Resuscitation and Disaster Medicine

基金湖北省十堰市科学技术研究与开发项目(编号:15Y25,16Y28)。

关键词无创机械通气蜂螫伤急性呼吸窘迫综合征 Non-invasive mechanical ventilation Wasp sting Acute respiratory distress syndrome

分类号 R563.8 [医药卫生—呼吸系统]

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参考文献5

1冼丽娜,杨远征,陈伟,孙广晓.降钙素原、超敏C反应蛋白及D-二聚体在脓毒症所致急性呼吸窘迫综合征中的诊断和预后评估价值[J].中国医药导报,2018,15(22):74-76. 被引量：15
2段辉,周坤,杨贤义,段斌,肖敏.血乳酸值和乳酸清除率对重症胡蜂蛰伤的预后价值[J].中国工业医学杂志,2018,31(5):324-327. 被引量：4
3詹庆元,黄絮.无创正压通气治疗急性低氧性呼吸衰竭的指征[J].中华医学杂志,2014,94(38):2966-2967. 被引量：14
4中国毒理学会中毒与救治专业委员会,中华医学会湖北省急诊医学分会,湖北省中毒与职业病联盟,杨贤义,肖敏.胡蜂螫伤规范化诊治中国专家共识[J].中华危重病急救医学,2018,30(9):819-823. 被引量：76
5郭辉,杨贤义,钟燕,李昌盛,柴林,肖敏.蜂蜇伤合并重度急性呼吸窘迫综合征1例[J].中国急救复苏与灾害医学杂志,2018,13(9):916-917. 被引量：4

二级参考文献56

1Hess DR. The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature [ J ]. Respir Care, 2004, 49 : 810-829.
2Masip J, Betbes6 A J, Ptez J, et al. Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomized trim [ J ]. Lancet, 2000, 356: 2126-2132.
3Nava S, Carbone G, DiBattista N, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial [J]. Am J Respir Crit Care Med, 2003, 168: 1432-1437.
4Vital FM, Saconato H, Ladeira MT, et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV ) for cardiogenic pulmonary edema [ J]. Cochrane Database Syst Rev, 2008 (3) : CD005351.
5Mehta S, A1-Hashim AH, Keenan SP. Noninvasive ventilation in patients with acute cardiogenie pulmonary edema [ J ]. Respir Care, 2009, 54:186-197.
6Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) [ J]. Eur Heart J, 2008, 29 : 2388-2442.
7Keenan SP, Sinuff T, Bums KE, et al. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting [J]. CMAJ, 2011, 183: E195-E214.
8Gray A, Goodacre S, Newby DE, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema [ J ]. N Engl J Med, 2008, 359: 142-151.
9Bach PB, Schrag D, Nierman DM, et al. Identification of poor prognostic features among patients requiring mechanical ventilation after hematopoietic stem cell transplantation [ J]. Blood, 2001, 98 : 3234-3240.
10Antonelli M, Conti G, Buff M, et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation : a randomized trial [ J ]. JAMA, 2000, 283 : 235-241.