有创与无创序贯通气疗法在COPD急性加重患者中的应用

Application of Sequential Invasive-noninvasive Mechanical Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

【目的】探讨有创-无创序贯疗法在慢性阻塞性肺疾病急性加重（Acute exacerbation of chronic obstructive pulmonary disease，AECOPD）患者中的疗效。【方法】将40例AECOPD患者随机分为两组，每组20例。治疗组给予有创-无创序贯机械通气，对照组给予有创机械通气，均给予常规疗法、营养支持及必要时给予支纤镜下灌洗等综合处理措施，观察两组患者病情变化，并对呼吸机相关肺炎（ventilators—associated pneumonia，VAP）、死亡数、气管切开发生率、气压伤发生率、机械通气时间、住院天数等进行对比研究。【结果】治疗组及对照组患者发生VAP的例数分别为2和8例（P〈0．05）；气管切开例数分别为0和8例（P〈0．01）；气压伤并发症例数分别为0和4例（P〈0．01）；总机械通气时间为（8．1±7．3）d和（15．2±8．3）d（P〈0．05）；住院时间为（11±5）d和（16±9）d（P〈0．05），死亡例数分别为0和5例。【结论】有创-无创序贯疗法结合支纤镜、营养支持及常规疗法等综合处理措施提高了AECOPD患者的疗效，特别是有创-无创序贯通气疗法可有效地改善治疗效果，提高生存率，降低VAP发生率，减少气管切开需求，减少气压伤发生率，减少机械通气时间，并降低医疗费用。

[ObjectivelTo investigate the therapeutic effects of sequential invasive-noninvasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. [Methods] Forty cases of AECOPD patients were divided into two groups with 20 cases for each. The therapy group was treated with sequential invasive-noninvasive mechanical ventilation,however the control group was treated with invasive mechanical ventilation. Both of groups were treated with other therapeutic methods such as general methods, nutrition support, and bronchoscope when necessary. Two groups were compared on the measures of the incidence rate of ventilators-associated pneumonia（VAP）,deaths, incision of trachea, barotraumas and duration of mechanical ventilation. [Results] Compared with the control group, the therapy group had lower rate of VAP（2/20,8/20, P 〈0. 05）,lower rate of incision of trachea（0/20,8/20, P 〈0. 05）, lower rate of barotraumas （0/20,4/20, P 〈0.05）, shorter duration of total mechanical ventilation[ （8.1 ± 7.3） d, （ 15.2 ± 8. 3）d, P 〈0.05], fewer days in hospital[（11±5）d,（16±9）d, P 〈0.05] and lower cases of deaths（0/20,5/20, P 〈0.01）. [Conclusion] Sequential invasive-noninvasive mechanical ventilation therapy combined with general methods, nutrition support and hronchoscopy can increase survival rate in patients with AECOPD. Among of these theraputic methods, sequential therapy was the most important. After complying the protocol of sequential invasive-noninvasive mechanical ventilation,the incidence of VAP, incision of trachea, barotraumas and deaths can be decreased,and the duration of mechanical ventilation and in hospital stay can be shortened, and the therapeutic effects can be improved obviously.