有创—无创序贯性通气在急性呼吸窘迫综合征患者撤机中的应用

The Application of Sequential Invasive-noninvasive Mechanical Ventilation in Weaning of Patients with ARDS

目的 :研究有创—无创序贯性通气在急性呼吸窘迫综合征 (ARDS)患者撤机中的应用和时机选择。方法 :随机将 38例ARDS患者分成有创 无创序贯通气治疗组 (A组 )和常规有创通气治疗组 (B组 )。A组由有创通气过渡到无创通气后撤机拔管 ,而B组则有创通气直至撤机拔管 ,比较两组呼吸机相关性肺炎 (VAP)发生率、病死率、总机械通气时间和入住重症监护病房 (ICU)的时间。结果 :A组与B组VAP发生率分别为 10 5 %和 78 9%例 (P <0 0 5 ) ;病死率分别为 2 1 1%和 5 7 9% (P <0 0 5 ) ;总机械通气时间分别为 (12± 5 )天和 (2 2± 11)天 (P <0 0 5 ) ;住ICU时间分别为 (15± 7)天和 (2 7± 12 )天 (P <0 0 5 )。结论 :ARDS机械通气患者当出现ARDS控制窗时改用无创通气可以降低VAP发生率 ,缩短机械通气和住ICU时间 。

Objective: To evaluate the effect and the optimal t ime for extubation and sequential noninvasive ventilation (NIV) in patients with ARDS who received invasive ventilation. Methods: Thirty eight p atients with ARDS who received endotracheal invasive ventilation were randomly a ssigned to apply immediately NIV after extubation (A group) and to continue inva sive ventilation (B group) at the time ARDS control window had appeared. The inc idence of ventilator-associated pneumonia (VAP), the mortality rate, duration o f total mechanical ventilation and intensive care unit (ICU) stay were compared between A group and B group. Results:The incidence of VAP (10.5 %) and the mortality rate (21.1%) in A group patients were significantly lowe r than those (78.9% and 57.9%, P<0.05,respectively) in B group patients . In A group patients, those with early extubation following NIV had the duratio n of total mechanical ventilation of (12±5)days and ICU stay of (15±7)days which were shorter than those of B group patients, who continued invasive venti lation until met weaning criteria (22±11)days and (27±12)days, P<0.05, respectively). Conclusion: At the time ARDS control window had ap peared, patients received invasive ventilation who were extubated promptly and a pply NIV immediately may decrease the incidence of VAP and mortality rate, short en duration of total mechanical ventilation and ICU stay. [