有创-无创序贯通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床研究

Clinical Research of Sequential Invasive to Noninvasive Ventilation on Treatment of Respiratory Failure Due to Chronic Obstructive Pulmonary Disease

目的探讨应用有创-无创序贯通气治疗慢性阻塞性肺疾病(COPD)急性加重合并严重呼吸衰竭的优越性。方法本研究设2组:常规通气组(n=20)和有创-无创序贯通气组(n=23)。有创-无创序贯通气组以"肺部感染控制窗"作为有创通气和无创通气之间的切换点。主要观测指标为:有创通气时间、机械通气总时间、1周以内再插管率、ICU(RICU)入住时间、呼吸机相关肺炎(VAP)发生率和序贯通气组血气指标、心率、血压的变化。结果有创-无创序贯通气组有创通气时间、再插管率、ICU(RICU)入住时间、呼吸机相关肺炎发生率显著低于常规通气组(P<0.05),序贯通气组无创通气治疗后的pH、氧分压、二氧化碳分压、氧合指数、心率、收缩压无明显变化(P>0.05)。结论采用有创-无创序贯通气治疗COPD急性加重合并严重呼吸衰竭较传统的有创通气方式更优越,能够有效缩短有创通气时间,降低VAP发生率,改善患者预后。

Objective To investigate the therapeutic efficacy of sequential invasive to noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease（COPD） complicated with severe respiratory failure.Methods The cases were assigned to 2 groups： invasive ventilation group（n=20） and sequential invasive to noninvasive ventilation group（n=23）.Pulmonary infection control window（PICW） was defined as switching point from invasive ventilation to noninvasive ventilation.The main clinical parameters observed were： the invasive ventilation period,total ventilation period,reintubation rate within one week,length of stay in ICU（RICU）,incidence of ventilator-associated pneumonia（VAP）and changes of arterial blood gas,heart rate,blood pressure in sequential invasive to noninvasive ventilation group.Results The invasive ventilation period and length of stay in ICU（RICU） of the cases in sequential invasive to noninvasive ventilation group were significantly shorter than that in invasive ventilation group（P〈0.05）.Incidence of VAP and rein-tubation rates were lower in sequential invasive to noninvasive ventilation group than that in invasive ventilation group（P〈0.05）.After all cases received noninvasive ventilation,the changes of pH、PaO2,PaCO2,PaO2/FiO2,heart rate,and SBP in sequential invasive to noninvasive ventilation group were not significant（P〉0.05）.Conclusion The results of sequential invasive to noninvasive ventilation is better than that of invasive ventilation for COPD with acute exacerbation resulting in severe respiratory failure as shown by effectively decreasing the invasive ventilation period,reducing the incidence of VAP and improving the patients＇ prognosis.