有创与无创序贯性机械通气在慢性阻塞性肺疾病并急性呼吸衰竭病人中的应用

SEQUENTIAL NON-INVASIVE FOLLOWING SHORT-TERM INVASIVE MECHANICAL VENTILATION IN COPD PATIENTS WITH EXACERBATE RESPIRATORY FAILURE

目的探讨慢性阻塞性肺疾病（COPD）并发急性呼吸衰竭病人从有创通气过渡到无创通气时机和效果。方法将26例COPD并发急性呼吸衰竭且实施有创机械通气的病人，待肺部感染明显控制时，随机分为两组，各13例。序贯组拔除气管插管，改用经鼻面罩压力支持通气＋呼气末正压（PSV＋PEEP）通气，以后渐减PSV水平直至脱离呼吸机；对照组继续按常规行有创机械通气，以SIMV＋PSV方式撤机。动态观察并比较两组通气及氧合指标、有创和总机械通气时间、住院天数、呼吸机相关肺炎的发生情况。结果序贯组与对照组治疗前各项指标比较差异无显著性（P〉0．05）。序贯组有创机械通气时间、总机械通气时间、住院天数较对照组明显缩短，差异有显著性（t′=2．545～3．498，P〈0．05、0．01）；呼吸机相关肺炎发生率低于对照组，差异有显著性（P=0．019）。结论对并发明显支气管、肺部感染行有创机械通气病人，以肺部感染明显控制为时机早期拔管，改用经鼻面罩无创通气可以显著改善治疗效果。

Objective To explore the optimal time of transition from invasive ventilation to sequential non-invasive ventilation for COPD patients with exacerbate respiratory failure. Methods Twenty six COPD patients with acute respiratory failure due to pulmonary infection were evenly divided into two groups in random when the infection was well controlled, an early extuba tion and non-invasive MV via faclal mask were done immediately in 13 patients （experimental group）, the other 13 patients kept on invasive MV （contronl group）. Results Before treatment, some items were similar in both groups; after treatment, invasive mechanical ventilation time, total mechanical ventilation time, and hospital stay were shorter （t′=2. 545 3. 498,P〈0.05,0.01） and the incidence of breating machlne-related pneumonia was lower as compared with the controls （P=0. 019）. Conclusion For patients with serious bronchial and pulmonary infection undergoing mechanlcal vetilation, early extubation should be done as soon as the infection is controlled, followed by non-invasive MV can improve the prognosis of COPD patients.