应用无创通气作为急性呼吸衰竭患者撤机方法的研究

Study of noninvasive ventilation as extubation and weaning technique in acute respiratory failure patients

目的评价接受机械通气治疗的急性呼吸衰竭(ARF)患者应用无创通气(NIV)撤机的临床效果。方法58例ARF患者经气管插管机械通气治疗48h后病情好转,尚未完全满足撤机条件时随机分为两组,NIV组:拔管立即给予NIV作为撤机方法;有创压力支持通气(IPSV)组:继续经人工气道给予PSV实施撤机。观察比较两组患者动脉血气变化、并发症发生率、机械通气时间和住院时间、再插管率和病死率。结果NIV组有创通气时间显著短于IPSV组(P<0.05),两组总的通气支持时间相似。NIV组呼吸机相关性肺炎(VAP)的发生率显著低于IPSV组(P<0.05),住院时间显著短于IPSV组(P<0.05)。两组再插管率和病死率相似。结论NIV用于接受机械通气的ARF患者撤机可缩短有创通气时间和住院时间,降低VAP的发生率。

Objective To assess the efficacy of noninvasive ventilation （ NIV ） in facilitating early extubation and weaning for the patients with acute respiratory failure （ ARF ） who received mechanical ventilation. Methods A prospective randomized controlled trial was conducted in 58 patients with ARF who met incompletely the criteria of weaning 48 hours after mechanical ventilation. The patients were randomly divided into NIV group （ n = 29, NW immediately after extubation ）, and IPSV group （ n = 29, invasive pressure support ventilation as the control weaning technique ）. Arterial blood gases were analyzed, and the rate of complications, duration of mechanical ventilation, lengths of hospital stay and outcome were observed. Results The duration of invasive mechanical ventilation was significantly shorter in the NIV group than in the IPSV group （ P 〈 0.05 ）. There were no differences in a total durations of ventilatory support between two groups. Compared with the IPSV group, NIV group had lower incidence of ventilator associated pneumonia （ VAP）, shorter period of hospital stays （ P 〈 0. 05 ）. The rate of reintubation and mortality were similar between two groups. Conclusion The use of NIV during weaning in patients with ARF can reduce duration of invasive mechanical ventilation and hospital stays, decrease the incidence of VAP.