无创-有创-无创序贯机械通气在慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭中的应用及护理监测

Application and Care Monitoring of Sequential Mechanical Ventilation in COPD with Respiratory Failure

目的探讨序贯机械通气在慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者中的治疗效果及护理监测。方法对96例重度COPD合并Ⅱ型呼吸衰竭患者进行气管插管并施行机械通气,"出窗后",随机分为序贯治疗组(48例)和对照组(48例),对照组给予常规机械通气治疗,序贯治疗组采用无创-有创-无创序贯机械通气治疗。两组同时进行监护,观察两组患者有创通气时间、总机械通气时间、呼吸重症监护病房(RICU)住院时间、呼吸机相关性肺炎(VAP)发生率、气管插管复插率及院内死亡例数。结果序贯治疗组和对照组有创通气时间分别为(74±31)h和(168±57)h、气管插管复插率分别为6.2%和31.2%,VAP发生率分别为2.1%和27.1%,两组患者的有创机械通气时间、气管插管复插率及VAP发生率间差异均有统计学意义(P<0.05)。结论在肺部感染控制窗指导下的无创-有创-无创序贯机械通气治疗方法,可以明显缩短机械通气时间,降低气管插管复插率及VAP发生率,结合有效的护理措施可有效改善治疗效果,是具有一定临床实用价值的有效脱机方案。

Objective To explore the treatment effectiveness of sequential mechanical ventilation in chronic obstructive pulmonary disease(COPD) with type Ⅱ respiratory failure and its nursing care monitoring.Methods Ninety-six severe COPD patients with type Ⅱ respiratory failure were given tracheal cannula and mechanical ventilation,and then divided randomly into treatment group(n=48) and control(n=48).The control group were given conventional mechanical ventilation treatment,and the treatment given sequential noninva...