以呼吸泵衰竭改善为切换点序贯通气治疗慢性阻塞性肺疾病呼吸衰竭的研究

Invasive-noninvasive sequential ventilation switched at respiratory pump improvement in chronic obstructive pulmonary disease with respiratory failure

目的探讨以呼吸泵衰竭改善为切换点进行有创-无创序贯性机械通气治疗慢性阻塞性肺疾病(COPD)呼吸衰竭的应用价值。方法纳入40例COPD并呼吸衰竭机械通气患者为研究对象。经抗感染及综合治疗,呼吸泵衰竭改善后,随机分为有创-无创序贯治疗组(序贯组)和常规治疗组(对照组)。序贯组立即拔除气管插管,应用无创正压通气(NPPV)支持脱机;对照组以常规有创机械通气方式脱机。比较两组有创机械通气时间、住ICU时间、呼吸机相关性肺炎(VAP)发生率、再插管率和病死率。结果序贯组21例,对照组19例,序贯组与对照组的有创机械通气时间为(2.6±0.7)d和(16.5±6.3)d,住ICU的时间为(3.0±0.8)d和(19.3±7.5)d,VAP发生率为14.29%(3/21)和36.8%(8/19),两组比较差异均有统计学意义(P均<0.05)。而两组再插管率为19.1%(4/21)和15.8%(3/19),病死率为14.3%(3/21)和26.2%(5/19),两组比较差异无统计学意义(P均>0.05)。结论对COPD呼吸衰竭需机械通气患者,以呼吸泵衰竭改善为切换时机,采用有创-无创序贯性机械通气治疗,可以缩短有创通机械气时间及住ICU的时间,降低VAP发生率。

Objective To evaluate the application of invasive-noninvasive sequential mechanical ventilation in chronic obstructive pulmonary disease （COPD） patients with severe hypercapnic respiratory failure at the switch-point of respiratory pump failure improved（RPFI）. Methods 40 COPD patients with severe hypercapnic respiratory failure who received invasive mechanical ventilation（ MV ）were involved in the study. At the switch-point of RPFI, the patients ventilation（ NPPV ）group and control group. The were randomized into noninvasive positive pressure early extubation was conducted and followed by noninvasive mechanical ventilation via facial mask immediately in the NPPV group. Invasive mechanical ventilation and conventional weaning technique was used in the control group. The incidence of VAP and reintubation,mortality ,the duration of invasive mechanical ventilation and days in ICU were analyzed and compared. Results 21 cases were randomized in NPPV group and 19 cases in control group. The duration of invasive mechanical ventilation was（ 2.6 ± 0. 7 ）d in NPPV group and（ 16. 5 ± 6. 3 ）d in control group（ P 〈 0. 05 ）. The durations of ICU stay was（ 3.0 ±0.8 ） d in NPPV group and（ 19. 3 ± 7.5 ） d in control group （ P 〈 0. 05 ）. The incidence of VAP was 14.29% （ 3/21 ） in the NPPV group and 36.8% （ 7/19 ） in control group（ P 〈 0. 05 ）. Hospital mortality was 14. 3% （ 3/21 ） in NPPV group and 26.2% （ 5/19 ） in control group（ P 〉 0.05 ）. The incidence of reintubation was 19. 1% （ 4/21 ） in NPPV group and 15.8% （ 3/19 ） in control group（ P 〉0. 05 ）. Conclusions A sequential invasive-noninvasive ventilation strategy switched as respiratory pump failure improved might short duration of invasive MV and ICU stay, decrease the occurrence of VAP in COPD patients with severe respiratory failure.