有创-无创序贯机械通气治疗COPD合并呼吸衰竭疗效观察

Effect of Sequential Mechanical Ventilation in Chronic Obstructive Pulmonary Disease Patients with Severe Respiratory Failure

目的探讨有创-无创序贯机械通气治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭的方法与疗效。方法将行气管插管机械通气的COPD合并呼吸衰竭的患者随机分为两组,在出现肺部感染控制窗(PIC)后,序贯组患者给予拔除气管插管,经口鼻面罩双水平气道正压通气;对照组继续有创通气,常规压力支持模式脱机。观察两组的有创通气时间、总机械通气时间、住ICU时间、总住院时间、呼吸机相关性肺炎发生率、再插管率、死亡率。结果序贯组与对照组的有创通气时间分别为(5.71±1.93)d和(12.53±4.52)d,住ICU时间为(8.76±2.73)d和(14.12±4.85)d,VAP发生率为5.88%和35.29%,两组比较差异均有统计学意义(P<0.05)。而两组的总机械通气时间分别为(10.35±2.55)d和(12.53±4.52)d;总住院时间为(18.35±3.59)d和(20.24±6.22)d;再插管率为5.88%和17.65%;死亡率为5.88%和11.76%,两组比较无统计学差异(P>0.05)。结论对COPD合并呼吸衰竭需机械通气治疗的患者,以肺感染控制窗为切换时机,有创-无创序贯机械通气治疗是更有效的方法,可以缩短有创机械通气时间及住ICU时间,降低VAP发生率。

Objective To investigate the method and effect of invasion and non-invasion sequential mechanical ventilation in chronic obstructive pulmonary disease（COPD）with severe respiratory failure. Methods Thirty-four COPD patients with severe respiratory failure were randomly divided into two groups. All the patients received endotracheal invasion ventilation. Seventeen patients of the treatment group were extubated and received non-invasion mechanical ventilation when the pulmonary infection control window appeared,while the other 17 patients of the control group were given conventional invasive pressure support ventilation continually. The invasion mechanical ventilation and total mechanical ventilation, the ICU stay and hospital stay, the ventilator-associated pneumonia（VAP） incidence,the reintubation,and the mortality were observed. Results In the treatment group,the time of invasion mechanical ventilation was（5.71 ± 1.93）d, while it was（12.53 ± 4.52）d in the control group（P〈 0.05）. The time of ICU stay in treatment group was shorter than that in the control group. The incidence of VAP was 5.88% in the treatment group,and 35.29% in the control group（P〈0.05）. The total mechanical ventilation time and hospital stay were（ 10.35 ± 2.55）d and（18.35 ± 3.59）d in the treatment group,while they were （12.53 ~ 4.52）d and （20.24 ± 6.22）d in the control group（P〉 0.05）. The reintubation rate and the mortality were 5.88% and 5.88% in the treatment group ,and 17.65% and 11.76% in the control group（P〉 0.05）. Conclusion In C OPD patients with severe respiratory failure who needed invasion mechanical ventilation,the sequential non-invasion following invasion mechanical ventilation at the appearance of PIC window can significantly reduce the time of invasion mechanical ventilation,ICU stay and the VAP incidence.