有创与无创序贯通气治疗慢性阻塞性肺病急性加重期临床研究

Control study of sequential invasive and non-invasive ventilation in the treatment of chronic obstructive pulmonary disease with acute exacerbation

目的比较有创与无创序贯通气治疗慢性阻塞性肺病急性加重期的疗效。方法所有患者均入住ICU病房,有创通气采用容量型辅助-控制方式(A/C)以后改为同步间歇强制通气+压力支持方式(SIMV+PSV),然后,根据患者的血气情况和耐受程度逐渐下调呼吸机参数,所有患者均同时应用抗感染、平喘、化痰等常规治疗。序贯通气组逐渐下调直至SIMV为10次/分左右,PSV为10cmH2O左右。如果患者无呼吸困难发生,则拔除气管插管,改用无创通气,IPAP在8～18cmH2O,EPAP在3～5cmH2O,根据血气调整呼吸机参数,直至撤机。对照组则继续采用有创通气,下调SIMV和PSV分别在5次/分和5cmH2O水平,撤机观察,如病情稳定超过4h则拔管。观察两组中机械通气的时间、住ICU时间、VAP的发生、病死率以及撤机的成功与失败的例数。结果有创机械通气时间,序贯组为(10±2)d,而对照组为(19±2)d(P<0.05),住ICU时间序贯组为(14±3)d,而对照组为(24±6)d(P<0.05),发生VAP的例数序贯组为1例,而对照组8例(P<0.05)。结论序贯通气治疗比对照组的机械通气时间,ICU留住时间,VAP的发生例数减少。

Objective To compare the effect of the sequential invasive and non-invasive ventilation in the treatment of chronic obstructive pulmonary disease with acute exacerbation.Methods All patients from the ICU ward were randomly divided into the sequential and the control group.Invasive ventilation were used volume-based aid-control（A/C）,and changing to the synchronized intermittent mandatory ventilation and pressure support mode（SIMV＋PSV）,then,ventilator parameters were gradually reduced according to the patient＇s blood gas situation and the tolerance.All patients were also used conventional treatment such as anti-infection,asthma,phlegm and etc.SIMVs were not gradually reduced until 10 times/min and PSVs were about 10 cmH2O in the sequential group.The removal of endotracheal intubation and noninvasive ventilation were done in the patients without breathing difficulty.IPAP and EPAP were controlled in the 8～18 cmH2O and 3～5 cmH2O,the ventilators were not adjusted based on the blood gas parameters until weaning.In control group,invasive ventilations were continued.SIMV and PSV were reduced respectively to 5 times/min and 5 cmH2O.Then intubations were removed after weaning and patients be stable for more than 4 h.The time ofinvasive mechanical ventilation,duration of ICU,the incidence of VAP,mortality,and the number of success or failure of weaning were compared.Results The time ofinvasive mechanical ventilation were（10±2）d in the sequential group and（19±2）d in the control group（P0.05）;the time in ICU were（14±3）d in the sequential group,while（24±6）d in the control group（P0.05）;the numbers of VAP occurrence were 1 patient in the sequential group and 8 patients in the control group（P0.05）.Conclusions The time of sequential ventilation,the time in ICU,and the cases of VAP occurrence in the sequential group were less than that in the control group.