有创与无创序贯通气治疗在COPD并急性呼吸衰竭中的应用

The application of sequential invasive-noninvasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) with acute respiratory failure (ARF)

目的探讨有创无创机械通气在COPD并急性呼吸衰竭中的疗效。方法将24例COPD并急性呼吸衰竭患者随机平均分为两组。治疗组给予有创-无创序贯机械通气,对照组给予有创机械通气,观察两组患者病情变化、血气分析、呼吸机相关肺炎(VAP)、死亡数、机械通气时间等。结果治疗组及对照组患者发生VAP的例数分别为0和4例(P<0.05),总机械通气时间为(12.26.2)d和(22.4±15.3)d(P<0.05);住院时间为(15±7)d和(18±14)d(P<0.05)。结论在适当时机将有创通气改为无创通气,可降低COPD并急性呼吸衰竭患者VAP发生率,缩短机械通气和住院时间,明显提高治疗效果。

Objective To investigate the therapeutic effects of chronic obstructive pulmonary disease （COPD） with acute respiratory failure using sequential invasive-noninvasive mechanical ventilation. Methods 24 COPD patients with ARF were divided into two groups, each group having 12 cases. The therapy group was treated with sequential invasive-noninvasive mechanical ventilation, and the contrast group was treated with invasive mechanical ventilation. The two groups were compared on the measures of progress of the disease, of blood gas analysis, of number of ventilators - associated pneumonia （VAP） , of deaths, and duration of mechanical ventilation. Results Compared with the contrast group, the therapy group had lower rate of VAP （0/12, 4/12,P 〈 0. 05 ） , shorter duration of total mechanical ventilation [ （ 12. 2 ± 6. 2） d, （22. 4±15.3） d,P 〈 0. 05 ], and fewer days in hospital [ （ 15 ±7 ） d, （ 18 ± 14） d,P 〈 0. 05 ]. Condusion Using properly while changing invasive mechanical ventilation into sequential invasive-noninvasive mechanical ventilation, the VAP rate of COPD with ARF can be shortened, the duration of mechanical ventilation and in hospital stay can be shortened, and the therapeutic effects can be improved obviously.