有创与无创序贯性机械通气治疗慢性阻塞性肺疾病所致呼吸衰竭的临床研究

Effects of sequential non-invasive following short-term invasive mechanical ventilation in chronic obstructive pulmonary disease patients with respiratory failure

目的探讨有创与无创序贯性机械通气在慢性阻塞性肺疾病（COPD）所致呼吸衰竭患者救治中的方法与疗效。方法对41例COPD呼吸衰竭患者进行气管插管并施行机械通气，出现HC窗后，随机分为序贯治疗组（21例）和对照组（20例）。序贯组治疗方法：出现PIC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：出现HC窗后，继续按常规有创机械通气方法治疗，按临床常用压力支持通气（PSV）模式脱机。两组同时进行监护，观察两组患者VAP发生例数、有创通气时间、总机械通气时间、ICU监护时间、住院时间、住院费用和院内死亡例数。结果序贯组与对照组比较，VAP发生少，有创通气时间、总通气时间、ICU监护时间及住院时间短，住院费用减少（P〈0．05），差异有统计学意义。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，可以明显降低VAP发病率，缩短机械通气，ICU和总住院时间，提高疗效，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 sequential non-invasive following shortterm invasive mechanical ventilation in chronic obstractive pulmonary disease （COPD）patients with respiratory failure. Methods 41 COPD patients with respiratory failure were divided into experiment group（ n = 21 ）and control group （ n = 20） randomly. At the time of pulmonary infection control （PIC） window, patients of experiment group were extubated and treated by non-invasive mechanical ventilation, then patients of control group were kept treating by invasive mechanical ventilation and weaned by PSV mode. The duration of invasive mechanical ventilation,total invasive mechanical ventilation, ICU and hospital stay, the VAP and death in hospital were compared between two groups. Results ： After treatment, the invasive mechanical ventilation time, total mechanical ventilation time, ICU and hospital stay were shorterand the incidence of VAP was lower（ P 〈 0. 05 ） as compared with the control group. Conclusion Sequential non-invasive following invasive mechanical ventilation at the PIC window is a may significantly decrease the invasive and total durations of ventilatory support, duration of ICU and hospital stay, the risk of VAP, and the cost of therapy, also increasing the efect of therapy.