无创正压通气在慢性阻塞性肺疾病所致严重呼吸衰竭机械通气脱机过程中的应用

Application of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease with mechanical ventilation

目的探讨无创正压通气在慢性阻塞性肺疾病(COPD)并发呼吸衰竭患者有创机械通气撤机后的应用时机及治疗效果。方法选择36例COPD患者,随机选取18例行气管插管机械通气并作为实验组,以同步间歇指令通气(SIMV)+压力支持通气(PSV)+呼气末正压(PEEP)方式行机械通气,待肺部感染控制窗出现,拔除气管插管,改为经面罩BIPAP无创通气,逐渐脱机。余18例做为对照组,行常规有创通气,最后以PSV方式至撤机。观察两组病例的呼吸机相关性肺炎(VAP)的发生例数、病死率、机械通气天数、总住院天数、动脉血气分析。结果实验组住院时间少于对照组,(21.1±1.8)天vs(27.1±1.4)天(P<0.05);机械通气时间为(11.4±0.8)天vs(14.8±2.4)天(P<0.05);呼吸机相关性肺炎发生率为0 vs 5例(P<0.01);死亡例数为1例vs 4例。实验组撤机前后血气分析比较差异无统计学意义(P>0.05);对照组撤机后pH降低、PaCO2升高(P<0.05)。结论对COPD并发呼吸衰竭患者采用早期有创机械通气,序贯应用无创正压通气可以显著降低VAP发生率,提高撤机成功率,缩短住院时间。

Objective To study the optimal time of mutual switch between invasive ventilation and noninvasive positive pressure ventilation（NIPPV） in treatment of the patients with chronic obstructive pulmonary disease（COPD） induced respiratory failure（RF） and the effect of NIPPV. Methods Eighteen COPD cases（study group） were treated by sequential non-invasive following short-term invasive mechanical ventilation （MV） when pulmonary infection had been controlled, the others COPD patients （control group） were treated with invasive MV continuously. Comparing the duration of invasive MV,the total duration of ventilatory support,the duration of hospitalization,mortality rate and the incidence of VAP. Results The duration of hospitalization in study group was shorter than that in control group, （21.1±1.8） d vs （27.1±1.4） d（ P 〈0.05）. The total duration of ventilatory support was （11.4±0.8） d vs （14.8± 2.4） d in two groups（ P 〈0.05）. The incidence of ventilator associated pneumonia was 0 vs 5（ P 〈0.01） ,1 vs 4 cases died respectively. Conclusion During MV of COPD patients with RF, it is very important to determine the optimal time to switch MV from invasive ventilation to NIPPV. A prompt change of MV mode can decrease the incidence of VAP, and decrease the duration of hospitalization.