基于改良格拉斯哥昏迷量表的慢性阻塞性肺疾病合并呼吸衰竭患者有创-无创序贯通气切换点研究

The Switching Point for Sequential Invasive to Noninvasive Ventilation in Patients with Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure based on the Improved Glasgow Coma Scale

目的比较分别以改良格拉斯哥昏迷量表(GCS)评分≥13、15分作为有创-无创序贯通气切换点,治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者的疗效。方法选取2015年3月—2017年3月于温州医科大学附属温岭医院急诊ICU行气管插管、机械通气治疗的COPD合并呼吸衰竭患者100例为研究对象,采用随机数字表法将患者分为A组和B组,各50例。A组、B组均接受有创机械通气(IMV),分别在改良GCS评分≥13、15分稳定3 h后,序贯进行无创机械通气(INV)。分别于拔管前及NIV后3 h记录平均动脉压、氧合指数、动脉血氧分压(Pa O_2)、动脉血二氧化碳分压(Pa CO_2)。记录两组IMV时间、再次插管发生率、呼吸机相关性肺炎(VAP)发生率、总住院时间。结果A组与B组拔管前、INV后3 h平均动脉压、氧合指数、Pa O_2、Pa CO_2比较,差异均无统计学意义(P>0.05)。同组拔管前与NIV后3 h平均动脉压、氧合指数、Pa O_2、Pa CO_2比较,差异均无统计学意义(P>0.05)。两组患者再次插管发生率比较,差异无统计学意义(P>0.05)。A组IMV时间、住院总时间短于B组,VAP发生率低于B组(P<0.05)。结论以改良GCS评分≥13分作为有创-无创序贯通气切换点治疗COPD合并呼吸衰竭患者,可缩短IMV时间、住院总时间,降低VAP发生率。

Objective To compare the therapeutic efficacy of improved Glasgow Coma Scale scores of≥13 and15 as the switching points for sequential invasive to noninvasive ventilation for the treatment of patients with chronic obstructive pulmonary disease（COPD）complicated with respiratory failure.Methods We enrolled 100 COPD patients complicated with respiratory failure,subjected to tracheal intubation and mechanical ventilation at the EICU,the Affiliated Wenling Hospital of Wenzhou Medical University,from March 2015 to March 2017.The patients were randomly divided into two groups（groups A and B）using a random number table,with 50 subjects in each group.All patients in groups A and B received invasive mechanical ventilation,and sequential noninvasive mechanical ventilation after the improved Glasgow Coma Scale score was kept stable at≥13 or 15 for 3 h.The mean arterial pressure,oxygenation index,arterial partial pressure of oxygen（Pa O2）,and arterial partial pressure of carbon dioxide（Pa CO2）were measured before extubation and 3 h after noninvasive mechanical ventilation.The duration of invasive mechanical ventilation,incidence of re-intubation,incidence of ventilator-associated pneumonia,and total hospital stay were recorded.Results There were no significant differences in the mean arterial pressure,oxygenation index,Pa O2,or Pa CO2 between groups A and B before extubation and 3 h after noninvasive mechanical ventilation（P〉0.05）.Furthermore,no significant differences were found in the mean arterial pressure,oxygenation index,Pa O2,or Pa CO2 between before extubation and 3 h after noninvasive mechanical ventilation in the two groups（P〉0.05）.In addition,the incidence of reintubation did not significantly differ between groups A and B（P〉0.05）.However,a significantly shorter duration of invasive mechanical ventilation and total hospital stay and a lower incidence of ventilator-associated pneumonia were found in group A compared to group B（P〈0.05）.Conclusion The use of an improved Glasgow Coma Scale score of≥13 as the switching point for sequential invasive to noninvasive ventilation may shorten the duration of invasive mechanical ventilation and total hospital stay and reduce the incidence of ventilator-associated pneumonia in the treatment of COPD patients complicated with respiratory failure.