无创与有创通气对AECOPD合并呼衰预后的影响

Affect of Noninvasive vs Invasive Mechanical Ventilation on Prognosis of AECOPD with Respiratory Failure

目的探索无创和有创通气对慢性阻塞性肺病急性加重(AECOPD)合并呼吸衰竭患者院内肺炎和病死率的影响。方法将AECOPD合并呼吸衰竭需要行机械通气患者80例,随机分为ETI(45例)和NIV(35例)组,记录院内肺炎发生率及病死率。结果AECOPD机械通气患者住ICU总病死率为22.5%;NIV/ETI组病死率为8.6%/33.3%(P=0.01);两组院内肺炎发生率为14.3%/35.5%(P=0.03)。NIV、院内肺炎、APACHEII是影响AECOPD患者病死率的独立危险因素。结论采用NIV治疗AECOPD合并呼吸衰竭,可降低病死率,其病死率降低与院内肺炎发病率下降有关。无创通气减少了ETI行有创通气的比率、缩短了机械通气及ICU停留时间。

Objective To evaluate the effect of noninvasive and invasive mechanical ventilation on the nosocomial pneumonia and mortality in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated with respiratory failure. Methods 80 cases suffered from AECOPD with respiratory failure received mechanical ventilation were randomized into endotracheal intubation group（ ETI, n = 45 cases） and noninvasive ventilation group （NIV, n = 35 cases）. The mortality and rate of nosocomial pneumonia between ETI and NIV group were compared. Results The mortality of all AECOPD patients admitted to ICU receiving mechanical ventilation was 22.5%. the NIV/ETI mortality was 8.6%/33.3% （ P =0.01 ） ,with nosocomial pneumonia being lg. 3%/35.5% （ P = 0.03）. NIV, nosocomial pneumonia and APACHEII were the independent risk factors affecting the mortality of AECOPD with respiratory failure receiving ventilation. Conclusion The NIV can reduce the mortality of AECOPD with respiratory failure, and the low mortality was related to the low prevalence rate of nosocomial pneumonia. NIV could reduce the ratio of needing ETI ventilation, and shorten the time of ventilation and staying in ICU.