有创-无创序贯性机械通气救治慢性阻塞性肺疾病合并严重呼吸衰竭的疗效观察

Therapeutic effect of sequential non-invasive following short-term invasive mechanical ventilation in treating chronic obstructive pulmonary disease complicating severe type Ⅱ respiratory failure

目的探讨有创-无创序贯性机械通气在慢性阻塞性肺疾病(COPD)合并严重Ⅱ型呼吸衰竭治疗中的方法与疗效。方法分析呼吸内科重症监护室(RICU)40例COPD合并严重Ⅱ型呼吸衰竭、分别接受有创-无创序贯性机械通气治疗(序贯组)与传统气管插管机械通气治疗(对照组)患者的病例资料,观察两组患者病情变化、血气分析结果、发生呼吸机相关肺炎(VAP)例数、死亡例数、有创和总机械通气时间、再插管率及住院时间。结果序贯组与对照组治疗前的血气分析结果相仿(P>0.05);发生VAP分别为1例和6例(P<0.05),死亡分别为1例和2例(P>0.05),有创机械通气时间分别为(5.9±2.2)d和(14.1±3.6)d(P<0.01),总机械通气时间分别为(12.2±6.2)d和(14.1±3.6)d(P<0.05),再插管例数分别为1例和2例(P>0.05),住院时间分别为(15±7)d和(19±4)d(P<0.05)。再插管率和死亡率两组之间比较无差异。结论对于COPD合并严重Ⅱ型呼吸衰竭的患者,以"肺部感染控制窗"为切换点,实施有创-无创序贯性机械通气,可降低VAP发生率,缩短机械通气时间和住院时间,是救治COPD合并严重Ⅱ型呼吸衰竭值得提倡的机械通气策略。

Objective To explore the methods and efficacy of sequential non-invasive following short-term invasive mechanical ventilation（MV） in the treatment of chronic obstructive pulmonary disease（COPD） complicating severe type Ⅱ respiratory failure.Methods The clinical data in 40 cases of COPD complicating type Ⅱrespiratory failure in Respiratory Intensive Care Unit（RICU） were retrospectively analyzed.These patients received either sequential non-invasive following short-term invasive MV（sequential treatment group） or tracheal intubation（control group）.The state of illness,blood gas results,incidence of ventilator associated pneumonia（VAP） and mortality,time of invasive and total MV,reintubation,hospitalization time were observed and compared.Results Both groups had similar clinical characteristics and blood gas results before treatment（P0.05）.Between the sequential treatment group and the control group,the incidence of VAP was 1/20 vs.6/20（P0.05）,the time of invasive MV was（5.9±2.2）d vs.（14.1±3.6） d（P0.01）,the time of total MV was（12.2±6.2）d vs.（14.1±3.6） d（P0.05）,hospitalization time was（15±7）d vs.（19±4）d（P0.05）,respectively.There was no difference between the two groups for the incidence of reintubation and mortality.Conclusion For COPD patients with severe type Ⅱrespiratory failure,early extubation followed by non-invasive MV at the switching point of pulmonary infection control（PIC） windows may decrease the incidence of VAP,duration of MV and hospitalization time,which should be a recommended strategy for MV in COPD with severe type Ⅱrespiratory failure.