以PIC窗为切点有创-无创序贯撤机的临床研究

Sequential non-invasive following short-term invasive mechanical ventilation initiated at the point of PIC window

目的观察慢性阻塞性肺病(COPD)并严重呼吸衰竭患者以肺部感染控制(PIC)窗为切点有创-无创序贯机械通气撤机的临床疗效。方法选择40例COPD并严重呼吸衰竭患者,均接受气管插管和机械通气,随机分为以PIC窗为切点有创-无创序贯撤机治疗组和有创通气传统撤机对照组,两组患者开始均采用气管插管进行有创机械通气,通气模式为辅助/控制模式逐渐过渡到压力支持通气。在PIC窗出现后治疗组序贯改用无创机械通气,直至脱机;对照组则继续有创通气,直至脱机。观察两组病例机械通气前后pH、PaO2、PaCO2、HR、RR、MAP及出现PIC窗时间,总机械通气时间、住ICU时问、总住院时间、呼吸机相关肺炎(VAP)发生率等。结果两组患者在PIC窗出现时循环、呼吸和血气指标均较机械通气前明显改善;治疗组总机械通气时间、住ICU时间、总住院时间较对照组明显缩短,有显著统计学差异(P<0.05),治疗组VAP发生率(15%)较对照组(62%)明显降低,有显著统计学差异(P<0.05)。结论以PIC窗为切换点行有创-无创序贯机械通气治疗COPD并严重呼吸衰竭能明显缩短机械通气时间和患者住院时间,明显降低VAP的发生率。

Objective To estimate the feasibility and the efficacy of early extubation and sequential non-invasive mechanical ventilation in COPD with exacerbated hypercapnia respiratory failure at the point of PIC window.Methods 40 intubated COPD cases with severe hypercapnia respiratory failure were involved in the study.At the time pulmonary infection had been significantly controlled（resolution of fever and decrease in purulent sputum,radiographic infictrations,and leukocytosis We call the time as ＂Pulmonary Infection Control Window＂PIC window） afer the antibiotic and the comprehensive therapy,the early extabation was conducted and followed by non-invasive MV via facial mask immediately in 20 cases（study group）.Other 20 COPD cases with similar clinical characteristics who continuously received invasive MV after PIC window were used as control group.Results The groups had similar clinical characteristics and gas exchange,initially and at the time of PIC window.For study group and control group,the total duration of ventilatory support was（11±5）vs（20±10） days,P0.05;the incidence of VAP were 16%vs 62%,P0.01 the duration of ICU stay was（14±6）vs（26±11） days,P0.05,respectively.Conclusion In COPD patients requiring intubation and MV for pulmonary infenction and hypercapnia respiratory failure,early extubation followed by non-invasive MV initiated at the point of PIC window may significantly decrease the invasive and total durations of ventilatory support,the risk of VAP,and the duration of ICU stay.