摘要
目的探讨呼吸衰竭患者肾上腺皮质功能对无创机械通气治疗效果的影响。方法于2010年2月—2015年8月选取在佛山市第四人民医院重症监护室(ICU)进行无创机械通气的呼吸衰竭患者120例。根据入院时的肾上腺皮质功能状态,将纳入患者分为肾上腺皮质功能正常组〔血浆皮质醇(COR)>3.0μg/dl,n=80〕和肾上腺皮质功能不全组(血浆COR≤3.0μg/dl,n=40)。比较两组患者治疗14 d后的康复情况,以及治疗前后的血浆COR水平、肺功能检查指标、心率和平均动脉压。结果两组性别、平均年龄、BMI、急性生理与慢性健康(APACHEⅡ)评分、原发病比较,差异无统计学意义(P>0.05)。肾上腺皮质功能不全组第1次达撤机标准时间、机械通气时间及入住ICU时间长于肾上腺皮质功能正常组,差异有统计学意义(P<0.05)。治疗前后肾上腺皮质功能不全组血浆COR水平均低于肾上腺皮质功能正常组,差异有统计学意义(P<0.05);治疗后两组血浆COR水平均高于治疗前,差异有统计学意义(P<0.05)。治疗前两组用力肺活量(FVC)、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)比较,差异无统计学意义(P>0.05);治疗后肾上腺皮质功能不全组FVC、FEV1/FVC低于肾上腺皮质功能正常组,差异有统计学意义(P<0.05);治疗后两组FVC、FEV1/FVC均高于治疗前,差异有统计学意义(P<0.05)。治疗前后两组心率、平均动脉压比较,差异均无统计学意义(P>0.05);治疗后两组心率、平均动脉压均低于治疗前,差异有统计学意义(P<0.05)。结论无创机械通气可以改善呼吸衰竭患者的肺功能,并促进患者心率和平均动脉压的恢复;而肾上腺皮质功能不全可延长患者的康复时间,影响患者肺功能的改善效果,进而影响患者预后。
Objective To investigate the influence of adrenal cortex function of respiratory failure patients on noninvasive mechanical ventilation treatment outcome. Methods From February 2010 to August 2015,120 respiratory failure patients in intensive care units（ ICU） of the 4th People＇ s Hospital of Foshan City were selected in this study. The selected patients were divided into the normal adrenal cortex function group 〔plasma cortisol（ COR） 3. 0 μg / dl,n = 80 〕and the adrenocortical insufficiency group（ plasma COR≤3. 0 μg / dl,n = 40） according to functional status of adrenal cortex of them at admission. 14 days after treatment, patients＇ rehabilitation condition, and plasma COR level, pulmonary function test index,heart rate and mean arterial pressure pre and posttreatment were also compared. Results There was no significant difference in gender,average age,BMI,acute physiology and chronic health evaluation Ⅱ score（ APACHE Ⅱ）,and protopathy between the two groups（ P〈0. 05）. The standard time of weaning for the first time,duration of mechanical ventilation and time of ICU stay of the adrenocortical insufficiency group were significantly longer than those in normal group（ P〈0. 05）. The plasma COR level of the adrenocortical insufficiency group pre and posttreatment was significantly lower than that of normal group（ P〈0. 05）;the plasma COR level of the two groups posttreatment was significantly higher than that of pretreatment（ P〈0. 05）. The forced vital capacity（ FVC） and the ratio of forced expiratory volume to FVC（ FEV1/ FVC） between two groups pretreatment showed no significant differences（ P〈0. 05）; FVC and FEV1/ FVC of the adrenocortical insufficiency group posttreatment were significantly lower than those of normal group（ P〈0. 05）; FVC and FEV1/ FVC between two groups posttreatment were significantly higher than those of pretreatment（ P〈0. 05）. The heart rate and average arterial pressure of the two groups pre and posttreatment showed no significant differences（ P〈0. 05）; The heart rate and average arterial pressure of the two groups posttreatment were significantly lower than those of pretreatment（ P〈0. 05）. Conclusion Noninvasive mechanical ventilation can improve the pulmonary function of patients with respiratory failure,and promote the recovery of patients＇ heart rate and average arterial pressure; but adrenocortical insufficiency will prolong the patient＇ s recovery time, affect the improvement of patients＇ pulmonary function,and then affect the prognosis of patients.
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第22期2661-2665,共5页
Chinese General Practice
基金
2013年广东省自然科学基金(S2013010011534)
关键词
呼吸功能不全
肾上腺皮质功能
机械通气
治疗结果
Respiratory insufficiency
Adrenal cortex function
Mechanical ventilation
Treatment outcome
