关键词: 结核,肺, HIV, 共病现象, 呼吸,人工, 治疗结果, 对比研究

Abstract:

Objective To explore the application value of lung protective ventilation strategy in mechanical ventilation treatment of patients with pulmonary tuberculosis (PTB) complicated with human immunodeficiency virus (HIV) infection and its effect on the prognosis of patients. Methods A retrospective study of 42 patients with PTB complicated with HIV infection who were hospitalized in the tuberculosis intensive care ward of the Chengdu Public Health Clinical Medical Center from January 2013 to December 2018 was conducted, including 21 patients treated with lung protective ventilation strategy as the observation group, and the 21 patients treated with conventional mechanical ventilation as the control group. The patients of the observation group were treated with mechanical ventilation under the lung protective ventilation strategy (tidal volume of 6-8 ml/kg, positive end-expiratory pressure (PEEP) of 5-10 cm H₂O (1 cm H₂O=0.098 kPa)), while the patients of the control group were treated with conventional mechanical ventilation (tidal volume of 10-12 ml/kg, PEEP of 0-4 cm H₂O). The changes of blood gas analysis indexes before and after mechanical ventilation treatment, as well as the differences in mean mechanical ventilation time, incidence of lung injury (VILI) caused by ventilator, incidence and mortality of ventilators associated pneumonia (VAP) were compared between the two groups. Results After 2 h of mechanical ventilation treatment, the oxygenation index of the observation group was (250.62±21.45) mm Hg (1 mm Hg=0.133 kPa), which was better than that of the control group ((218.23±18.63) mm Hg), and the difference was statistically significant (t=21.56, P=0.028). The average ventilation time in the observation group was (4.92±1.13) d, which was significantly shorter than that in the control group ((8.74±2.35) d), and the difference was statistically significant (t=2.73, P=0.033). The incidence of VILI in the observation group was 4.8% (1/21), which was significantly lower than that in the control group (19.0% (4/21)), and the difference was statistically significant (Fisher exact probability, P=0.027). The incidence of VAP in the observation group was 9.5% (2/21), which was significantly lower than that in the control group (28.6% (6/21)), with the statistically significant difference (Fisher exact probability, P=0.031). Conclusion The lung protective ventilation strategy is superior to the conventional ventilation strategy in improving the therapeutic effect of mechanical ventilation, reducing the incidence of VILI and VAP, and shortening the treatment time of mechanical ventilation in patients with PTB complicated with HIV infection.

Key words: Tuberculosis, pulmonary, HIV, Comorbidity, Respiration, artificial, Treatment outcome, Comparative study