对慢性阻塞性肺疾病呼吸衰竭机械通气治疗的再认识

Recognition of mechanical ventilation used in the rreatment of chronic obstructive pulmonary disease with respiratory failure

目的探讨对慢性阻塞性肺疾病(COPD)呼吸衰竭机械通气的策略。方法回顾性总结82例需机械通气的COPD患者的治疗情况。结果75例患者脱机成功(91.5%)死亡7例(8.5%)。相关并发症:呼吸机相关肺炎8例,气管导管阻塞6例,单肺通气3例,低血压2例,气胸1例。结论及早行机械通气是治疗呼吸衰竭最有效和迅速的方法,加强气道管理、合适的通气策略、营养支持、控制感染是减少并发症和提高抢救成功的关键。

Objective To investigate the tactics of mechanical ventilation used in the treatment of chronic obstructive pulmonary disease （COPD） with respiratory failure. Methods Retrospective summary was made about the treatment effect using mechanical ventilation of the chronic obstructive pulmonary disease with respiratory failure. Results Of all the 82 cases, 75 were treated with success. Seven patients died. The related complications in the course of treatment included ventilator - associated pneumoia （ n = 8 ）, tracheal tube obstruction （ n = 6） , single lung ventilation （ n = 6 ） , low blood pressure （ n = 2 ）, and pneumothorax （ n = 1 ）. Conclusion Early mechanical ventilation is the most effective and rapid method in treating respiratory failure. The keys of reducing complications and successful lifesaving include enhancement of airway management, appropriate use of ventilation strategy, nutritional support, and control of infections.