有创-无创序贯机械通气救治非COPD急性严重呼吸衰竭的疗效观察

The efficacy of sequential invasive to noninvasive mechanical ventilation in treatment of none COPD severe respiratory failure

目的探讨有创-无创序贯机械通气救治非COPD病因所致急性严重呼吸衰竭的临床效果及应用价值。方法选择非COPD病因所致急性严重呼吸衰竭患者20例为序贯通气组,先经口气管插管有创通气,根据病情在3~7 d内拔除气管插管改为无创正压通气;选择相似病情病例20例作为对照组,经口气管插管有创通气,以同步间歇强制通气＋压力支持通气方式撤机。观察两组病例的机械通气时间、呼吸机相关性肺炎（VAP）发生率、撤机成功率、住院死亡率、总住院时间等。结果序贯通气组VAP发生率、有创通气时间、总机械通气时间、总住院时间明显低于对照组（P〈0.05）。结论有创-无创序贯机械通气策略不仅可应用于COPD所致的重症呼吸衰竭,对非COPD病因所致急性严重呼吸衰竭的救治也具有一定优势。

Objective To evaluate the efficacy of sequential invasive to noninvasive mechanical ventilation（MV） in treatment of none COPD severe respiratory failure. Methods 20 patients with none COPD severe respiratory failure due to different causes were as- signed to the sequential therapy group. After 3-7 days intubation and invasive positive pressure MV, the extubation was conducted and followed by noninvasive MV. Other 20 cases with similar clinic characteristics who continuously received invasivc MV were assigned to control group, then the duration of MV, the incidence of ventilator-associated pneumonia（ VAP）, the incidence of death, total hospitalization time were compared. Results Patients in the sequential therapy group showed less incidence of VAP,invasive MV duration, total MV duration, and total hospitalization time compared to control subjects （ P 〈 0. 05 ）. Conclusion Sequential invasive to noninvasive MV strategy not only could be used in treatment of severe respiratory failure of COPD, but also could be used in treatment of severe respiratory failure caused by none COPD.