不同通气模式在慢性阻塞性肺疾病合并呼吸衰竭方面的效果比较

The comparison on the effect of different ventilation modes in chronic obstructive pulmonary diseases combined with respiratory failure

目的 探讨比较不同通气模式在慢性阻塞性肺疾病（COPD）合并呼吸衰竭中的效果.方法 选取50例COPD合并呼吸衰竭患者,按随机数字表法分为A组和B组,每组25例,均采用有创通气,出现肺部感染控制窗后分别采用同步间歇指令通气（SIMV）＋压力支持通气（PSV）和PSV＋呼气末正压（PEEP）模式进行治疗,比较两组患者的机械通气时间、住院时间、再插管、并发症及治疗前后的血清白细胞介素（IL）-8、超敏C反应蛋白（hs-CRP）、IL-4、干扰素（IFN）-γ水平.结果 B组的机械通气时间、住院时间短于A组[（11.8±2.3）、（16.8±3.2）d比（20.3±2.0）、（28.8±4.1）d],再插管率、并发症发生率均低于A组[8%（2/25）、8%（2/25）比24%（6/25）、24%（6/25）],而治疗后B组出现肺部感染控制窗后24、48 h的血清IL-8、hs-CRP、IL-4、IFN-γ水平均低于A组,差异有统计学意义（P＜0.05）.结论 COPD合并呼吸衰竭行机械通气患者在出现肺部感染控制窗后及早行鼻面罩给氧效果更好,应引起重视.

Objective To study and compare the effect of different ventilation modes in chronic obstructive pulmonary diseases （COPD） combined with respiratory failure. Methods Fifty patients with COPD combined with respiratory failure were divided into group A and group B with 25 cases each by random digits table,and they were treated with invasive positive pressure ventilation. Then the two groups were respectively treated with synchronized intermittent mandutory ventilation （SIMV） ＋ pressure suppert ventilation （PSV） and PSV ＋ positive end-expiratory pressure （PEEP） after appearing the pulmonaryinfection-control- window. And the time of mechanical ventilation, length of hospital stay, reintubation rate, complication rate and serum interleukin （IL）-8,high Sensitiveity c-reactive protein （hs-CRP）, IL-4 and interferon （IFN）- γ of the two groups before and after the treatment was analyzed and compared. Results The time of mechanical ventilation and length of hospital stay in group B was shorter than that in group A [（11.8 ± 2.3）, （16.8 ± 3.2） d vs. （20.3 ± 2.0）, （28.8 ± 4.1） d], and the reintubation rate and complication rate was lower than that in group A [8%（2/25）, 8%（2/25） vs. 24%（6/25）, 24%（6/25）]. The levels of serum IL-8, hs-CRP, IL-4 and IFN- 7 were lower in group B than those in group A （P 〈 0.05）. Conclusion The effect of nasal mask inhaled oxygen early given to COPD combined with respiratory failure is better, and it should be paid attention to.