慢性阻塞性肺疾病重症呼吸衰竭序贯机械通气治疗的疗效研究

Analysis of sequential mechanical ventilation in chronic obstructive pulmonary direase patients with severe respiratory failure

目的创与无创序贯性机械通气在慢性阻塞性肺疾病（COPD）重症呼吸衰竭患者救治中的方法与疗效。方法对30例COPD重症呼吸衰竭患者进行气管插管并施行机械通气，“出窗后”，随机分为序贯治疗组和对照组，序贯组治疗方法：出窗后，立即拔出气管插管，改用口鼻面罩双水平气道正压通气（BiPAP）；对照组治疗方法：肺部感染控制窗出现后，继续按常规有创机械通气方法治疗，以目前临床常用压力支持通气（PS）模式脱机。两组同时进行监护，观察两组患者有创通气时间、呼吸机相关肺炎（VAP）发生例数、总机械通气时间、住院时间、监护时间、撤机成功例数、住院费用和院内死亡例数。结果两组患者发生VAP的例数分别为0和7例（P〈0．05），总机械通气时间为（12．2±1．2）d和（18．4±1．5）d（P〈0．05）；住院时间为（16．3±1．8）d和（26．4±3．9）d（P〈0．01）。结论在肺部感染控制窗指导下的有创一无创序贯性脱机治疗方法，可以明显缩短机械通气，降低VAP发病率，缩短ICU和总住院时间，改进治疗效果，降低治疗费用，是具有一定临床实用价值的有效脱机方案。

Objective To research the method and effect of squential non-invasive following short-term invasive mechanical ventilation in COPD patients with severe respiratory failure. Methods Thirty COPD patients with severe respiratory failure were studied. When pulmonary infection had been controlled, half of the patients（treatment group）were extubated and treated by non-invasive mechanical ventilation＇the other half（control group）were kept treating by invasive mechanical ventilation and weaned by PSVmode-The duration of invasive mechanical ventilation and total invasive mechanical ventilation and hospitalization and care, the incidence of ventilator-associated pneumonia（VAP）and successive weaning and death in hospital, exhausting in hospital were compared between treatment group and control group. Results For treatment group and control group, the incidence of VAP was 0 vs 7 cases （P〈0.05）; the total duration of mechanical ventilation was（12.2 ± 1.2）d vs （18.4±1.5）d（P 〈0.05）; the duration of hospitalization was（16.3 ±1.8） d vs（26.4 ±3.9） d（P〈0.01）.Conclusion Sequential non-invasive following invasive mechanical ventilation at the time of pulmonary infection control（PIC）window is a valuable and effective project by decreasing the duration of mechanical ventilation hospitalization, as well as the cost of therapy, also increasing the effect of therapy.