不同机械通气方法治疗慢性阻塞性肺疾病合并呼吸衰竭

A Retrospective Study on the Treatment of Chronic Obstructive Pulmonary Disease with Respiratory Failure by Mechanical Ventilation

目的:评价经面罩机械通气(FMMV)治疗慢性阻塞性肺疾病急性加重(AECOPD)所致呼吸衰竭的疗效;并与人工气道机械通气(ETMV)进行比较。方法:选择2003年1月-2007年1月收住急诊重症监护室(EICU)符合入选标准的AECOPD呼吸衰竭患者,进行FMMV与ETMV比较。结果:FMMV能在4h内改善患者意识状态和动脉血气,其通气时间、住ICU时间及住院时间比ETMV缩短;气管插管率、住院病死率和呼吸机相关性肺炎发生率均低于ETMV。FMMV组患者中,Kelly评分3分组患者的气管插管率低于4～6分组。结论:FMMV能成功应用于大部分AECOPD呼吸衰竭患者,对于意识障碍程度较重患者,要谨慎应用。

Objective：To compare the effect of face mask mechanical ventilation（FMMV） and endotracheal intubation mechanical ventilation （ETMV）for the treatment of chronic obstructive pulmonary diseases （COPD） with respiratory failure （RF）. Methods：COPD patients with RF in EICU were compared about FMMV and ETMV from 2003 to 2007. Results： FMMV improved consciousness and arterial blood gas levels in 4 hours;in the FMMV group,the ventilation times,length of ICU stay and hospital stay were shorter than those with ETMV;the mortality of inpatients,the rate of need for intubation, and ventilator-associated pneumonia were lower in FMMV group. Kelly score, 3 patients in FMMV group,the rate of need for intubation was lower than those 4-6. Conclusion： FMMV could be successfully applied to most COPD patients with RF, but it must be performed carefully in patients with severely altered level of consciousness.