无创正压通气治疗重症社区获得性肺炎临床疗效和预后影响

摘要 目的：考察无创正压机械通气(noninvasive positive-presure ventilation，NIPPV)对重症社区获得性肺炎(Severe community acquired Pneumonia，SCAP)的治疗效果和预后的影响。方法：以2018年7月-2020年2月我院收治的80例SCAP患者为研究对象，采用随机数字法分为无创组和常规组，各40例。两组患者均在在入院后均接受常规治疗，无创组在常规治疗的基础上进行NIPPV治疗。详细记录患者治疗前和治疗后1 h、24 h的体温、呼吸、血压、心率、血二氧化碳分压(arterial partial pressure of CO₂，PaCO₂)、氧合指数(PaO₂/FIO₂)、气管插管率、病死率、ICU住院天数，对患者入院的第1、3、7 d的血清可溶性尿激酶型纤溶酶原激活物受体(soluble urokinase-plasminogen activator receptor，suPAR)、降钙素原(procalcitonin，PCT)及C反应蛋白(C-reactive protein，CRP)的水平进行检测。结果：治疗后1 h和24 h，无创组患者呼吸、心率、PaCO₂、PaO₂/FIO₂和PH均显著的改善（P＜0.05），显示NIPPV可明显改善患者肺部气体交换，减慢呼吸频率、提高氧和指数，降低二氧化碳分压；第1 d两组患者的PCT、CRP和suPAR的水平无明显差异（P＞0.05），相对于第1 d，两组患者第3 d和第7 d的PCT、CRP和suPAR水平均明显的降低（P＜0.05）；相对于常规组，第3 d和第7 d无创组患者的PCT、CRP和suPAR水平有显著的降低（P＜0.05）；与常规组相比，无创组患者的插管率、ICU住院天数和死亡率统计学上无显著差异（P＞0.05），但均有一定程度上的降低。结论：NIPPV能显著改善SCAP患者的呼气情况，降低血清PCT、CRP和suPAR水平，对降低气管插管率、缩短ICU住院天数，降低患者死亡率有一定的效果。

Clinical Efficacy and Treatment of Non-invasive Positive Pressure Ventilation in the Treatment of Severe Community-acquired Pneumonia Prognostic Impact

ABSTRACT Objective: To investigate the effect of noninvasive positive pressure ventilation on the treatment effect and prognosis of severe community-acquired pneumonia. Methods: Taking 80 patients with SCAP admitted to our hospital from July 2018 to February 2020 as the research object, they were divided into non-invasive group and routine group by random number method, 40 cases each. Both groups of patients received conventional treatment after admission, and the non-invasive group received NIPPV treatment based on conventional treatment. The patient''s body temperature, respiration, blood pressure, heart rate, PaCO₂, PaO₂/FIO₂, endotracheal intubation rate, fatality rate, and ICU hospitalization days were recorded before and after treatment. The serum PCT, CRP and suPAR levels on the first, third and seventh days of the patients'' admission were tested. Results: 1 h and 24 h after treatment, the patients in the noninvasive group had significant improvement in respiration, heart rate, PaCO₂, PaO₂/FIO₂ and PH(P<0.05), It shows that NIPPV can significantly improve the gas exchange in the lungs of patients, slow down the respiratory rate, increase oxygen and index, and reduce the partial pressure of carbon dioxide. On the first day, there was no significant difference in the levels of PCT, CRP and suPAR between the two groups (P>0.05). Compared with the first day, the PCT, CRP and suPAR levels on the third and seventh days of the two groups of patients were significantly reduced (P<0.05). Compared with the conventional group, the PCT on the third and seventh days of the noninvasive group, CRP and suPAR levels were significantly reduced(P<0.05). Compared with the conventional group, there was no statistically significant difference in the intubation rate, ICU hospital stay, and mortality in the noninvasive group (P>0.05), but they all decreased to a certain extent. Conclusion: NIPPV can significantly improve the expiratory condition of SCAP patients, reduce serum PCT, CRP and suPAR levels, have a certain effect on reducing the rate of tracheal intubation, shortening the length of hospital stay in ICU and reducing the mortality of patients.