序贯机械通气治疗慢性阻塞性肺疾病并呼吸衰竭的疗效观察

Observation Of Potency Effect Of Sequential Mechanical Ventilation In Acute Exacerbation Of COPD Patients With Severe Respiratory Failure

目的：观察有创-无创序贯性机械通气策略在慢性阻塞性肺疾病急性加重期并呼吸竭治疗中的疗效。方法：将诊断为AE—COPD需要机械通气的34例患者随机分为序贯组和对照组：序贯组18例，对照组16例。两组均先给予有创机械通气（IPPV）治疗，在患者“肺部感染控制窗（PIC）”出现后，序贯组予以拔出气管插管，改用无创正压通气（NPPV）直至脱机，对照组仍用IPPV，以PSV的方法直至脱机。动态观察两组患者的总机械通气时间，有创机械通气时间，呼吸机相关性肺炎（VAP）发生率，再插管率和院内死亡率。结果序贯纽和对照纽的有创机械通气时间分别为（6±2．5天）和（13．5±8天）机械通气时间分别为（11±3．5天）和（14士7．5天），VAP发生率分别为2例和10例，再插管率分别为3例和3例，死亡率分别为11％和25％结论：有创-无创序贯机械通气可显著提高慢性阻塞性肺疾病并呼吸衰竭患者机械通气撤机的成功率，缩短有创机械通气（IPPV），总机械通气时间，降低VAP发生率，减少再插管率和死亡率。

Objective：To observe the potency effect of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease （COPD） patients with severe respiratory failure. Methods： The 34 patients subjected to mechanical ventilation were diagnosed the acute exacerbation of COPD and divided into sequential group and control group randomly： 18 patients in sequential group,16 patients in control group. In the beginning,IPPV was adopted in two groups. When the pulmonary infection was significantly controlled （the time was called PIC window ）, the extubation was conducted and followed rainvasive ventilation （NIPPV） via facial mask in sequential group; the patients in control group continued to receive invasive ventilation （IPPV） and plus pressure support ventilation （PSV） was used as the weaning technique in control group. The duration of mechanical ventilation, the incidence rate of ventilation--associated pneumonia, the incidence rate of reintubation and death rate were examined. Results In sequential group, the duration of invasive mechanical ventilation（IPPV） and total IPPV were（6±2.5d）and （11±3.5d）, while the durations were（13.5±8d）and （14±7. 5d）. The incidence of ventilation associated pneumonia （VAP） was 2/18 in the sequential group and 10/16 in control group. The incidence of reintubation was 16.6% （3/18i） in sequential group and 18. 7% （3/16） in control group. Hospital mortality was 11% in sequential group and 25% in control group. Conclusion In the acute exacerbation of COPD require sequential non--invasive follow invasive mechanical ventilation may decrease the duration of IPPV and total duration of mechanical ventilation, the risk of VAP, the risk of reintubation and Hospital mortality.