有创-无创序贯机械通气治疗AECOPD合并Ⅱ型呼吸衰竭的临床研究

Clinical Research of Sequential invasive-noninvasive Mechanical Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Ⅱ respiratory failure

目的探讨有创-无创序贯机械通气在慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者治疗中的疗效。方法将符合条件的48例AECOPD患者随机分为两组。在"肺部感染控制窗(PIC窗)"出现后,序贯治疗组拔除气管插管,应用口鼻面罩双水平正压通气直至脱机;对照组继续给予有创机械通气,以压力支持方式脱机。观察两组患者有创通气时间、总机械通气时间、重症监护病房(ICU)住院时间、呼吸机相关性肺炎(VAP)发生率、气管插管复插率及院内死亡例数。结果序贯治疗组和对照组有创通气时间分别为(5.34±0.48)h和(12.6±1.21)d、气管插管复插率分别为8.33%和33.3%。VAP发生率分别为8.3%和41.7%,两组患者的VAP发生率、再插管率、有创通气时间和住ICU时间均有统计学意义(P<0.05)。两组患者死亡率无明显差异(P>0.05)。结论在肺部感染控制窗指导下的有创-无创序贯机械通气治疗方法,可缩短机械通气时间,降低VAP发生率及气管插管复插率,具有临床实用价值的比较有效脱机方案。

Objective To study the efficacies of sequential non-invasive following short-term invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods Forty-eight AEOOPD patients intubated were randomly divided into two groups each group having 24 cases. The study group was treated with sequential non-invasive following short-term invasive mechanical ventilation when pulmonary infection had been controlled（ PIC window） ,and the control group was treated with invasive mechanical ventilation continually. And the changes of the clinical characteristics, the incidence of ventilators-associated pneumonia（VAP） and deaths, the duration of mechanical ventilation, days in hospital were compared. Results Sequential treatment group and control group, invasive ventilation time was （5.34±0. 48） h and （ 12.6±1.21 ） d, re-inserted endotracheal intubation rates were 8.33% and 33.3%. VAP rates were 8.3% and 41.7%, two groups of patients the incidence of VAP, re-intubation rate, invasive venti- lation and ICU stay time were statistically significant （ P 〈0. 05 ）. No significant difference in mortality of two groups （ P 〉0. 05 ）. Conclusion Sequential noninvasive-invasive mechanical ventilation under the guidance of pulmonary infection control window can shorten the duration of mechanical ventilation, reduce interpolation rate of VAP and reintubatiou rate. It is of certain clinical value.