摘要
目的观察重症肺炎机械通气患者吸痰前后心率变异性与撤机困难的关系,为未来重症肺炎机械通气困难撤机结局患者的风险评估与干预提供新方向。方法抽取2018年2月至2019年5月于驻马店市中心医院就诊并完成治疗与随访的96例重症肺炎机械通气患者的病历资料。记录全部患者吸痰前后的心率变异性;依据困难撤机结局的发生情况分为发生组与未发生组,对比两组吸痰前后的心率变异性;分析心率变异性与困难撤机结局的关系。结果重症肺炎患者吸痰前后的全部正常窦性心搏RR间期的标准差( SDNN)、每5 min R-R间期差值的均方根(SDANN)、全程相邻R-R间期差值的均方根(RMSSD)、相邻R-R间期差值>50 ms的个数占R-R间期总数的百分比(PNN50)比较,差异未见统计学意义(P>0.05)。患者吸痰后的总频谱(TF)、低频(LF)、高频(HF)低于吸痰前,LF/HF高于吸痰前(P<0.05)。96例重症肺炎机械通气患者中,发生困难撤机者25例,发生率为26.04%;发生组吸痰后的TF、LF、HF低于未发生组,LF/HF高于未发生组(P<0.05),其他基线资料及相关指标组间比较差异未见统计学意义(P>0.05)。经Logistic回归分析检验结果显示,TF、LF、HF、LF/HF均是重症肺炎机械通气患者困难撤机结局发生的影响因素(OR均>1,P均<0.05)。结论重症肺炎机械通气患者心率变异性若显示有异常变化,可能提示困难撤机结局高风险,这类患者应引起临床重视,尽早给予合理干预,对减少患者死亡、延长生存时间及改善预后意义重大。
Objective To observe the relationship of heart rate variability before and after sputum aspiration with difficult weaning in patients with severe pneumonia undergoing mechanical ventilation,and to provide new directions for risk assessment and intervention for patients with severe pneumonia and difficult weaning undergoing mechanical ventilation in the future.Methods The medical records were retrospectively analyzed and collected from 96 mechanically ventilated patients with severe pneumonia who were diagnosed,treated and followed up in Zhumadian Central Hospital from February 2018 to May 2019.The heart rates variability of all patients before and after sputum aspiration were recorded.According to the outcome of difficult weaning,the patients were divided into the occurrence group and the non occurrence group.The heart rate variability before and after sputum suction was compared between the two groups;and the relationship between heart rate variability and the outcome of difficult weaning was analyzed.Results There was no significant difference in standard deviation of all normal R-R intervals(SDNN),standard deviation of average RR interval in 5-min segments(SDANN),root mean square values of the standard deviation between adjacent normal number of intervals(RMSSD),percentage of differences exceeding 50 ms between adjacent normal number of intervals(PNN50)before and after sputum aspiration in patients with severe pneumonia(P>0.05).The total frequency(TF),low frequency(LF),and high frequency(HF)of patients after sputum aspiration were lower than those before sputum aspiration,and LF/HF was higher than that before sputum aspiration(P<0.05).In 96 cases of severe pneumonia patients with mechanical ventilation,25 cases were difficult to wean,and the incidence rate was 26.04%.TF,LF and HF after sputum aspiration in the occurrence group were lower than those in the non-occurring group,and LF/HF was higher than that in the non-occurring group(P<0.05).There was no significant difference in other baseline data and related indicators between the two groups(P>0.05).Logistic regression analysis showed that TF,LF,HF,and LF/HF were all influencing factors for the difficult weaning outcome in severe pneumonia patients with mechanical ventilation(all OR>1,all P<0.05).Conclusions Abnormal changes of heart rate variability in patients with severe pneumonia undergoing mechanical ventilation may indicate high risk of difficult weaning outcome.Clinicians should pay attention to these patients and give reasonable intervention as soon as possible,which is of great significance for reducing deaths,prolonging survival time,and improving prognosis.
作者
甘文云
王运
刘辉
申国庆
徐敬敬
Gan Wenyun;Wang Yun;Liu Hui;Shen Guoqing;Xu Jingjing(Department of Respiratory and Critical Care Medicine,Zhumadian Central Hospital,Zhumadian 463000,China)
出处
《中国实用医刊》
2021年第15期77-81,共5页
Chinese Journal of Practical Medicine
关键词
肺炎
机械通气
吸痰
心率变异性
困难撤机
相关性
Pneumonia
Mechanical ventilation
Sputum suction
Heart rate variability
Difficult weaning
Correlation
