有创-无创序贯通气治疗慢性阻塞性肺疾病并呼吸衰竭的疗效

Sequential invasive and noninvasive ventilation as treatment of respiratory failure due to chronic obstructive pulmonary disease

目的:探讨应用有创-无创序贯通气治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭的疗效。方法:将符合标准的COPD合并呼吸衰竭患者83例,随机分为观察组44例和对照组39例。观察组患者采用有创-无创序贯通气治疗,对照组患者采用有创通气治疗。观察两组患者有创通气时间、总机械通气时间、ICU入住时间、呼吸机相关性肺炎(VAP)发生率、再插管率和观察组血气指标、心率、血压的变化。结果:观察组有创通气时间、再插管率、ICU入住时间、呼吸机相关肺炎发生率显著低于对照组(P<0.05),观察组无创通气治疗后的pH、氧分压、二氧化碳分压、氧合指数、心率、收缩压无明显变化(P>0.05)。结论:采用有创-无创序贯通气治疗COPD合并呼吸衰竭能够有效缩短机械通气时间、住院时间,降低VAP发生率,改善患者预后。

Objective： To investigate the therapeutic efficacy of sequential invasive and noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease （COPD） complicated with severe respiratory failure. Methods： A total of 83 patients with chronic obstructive pulmonary disease （COPD） complicated with severe respiratory failure were randomly divided into observed group （44 cases） and control group （39 cases）, patients in control group only received invasive ventilation, while others received invasive and noninvasive ventilation. The main clinical parameters observed were： the invasive ventilation period, total ventilation period, reintubation rate within one week, length of stay in ICU, inci- dence of ventilator-associated pneumonia （VAP） and changes of arterial blood gas, heart rate, blood pres- sure in sequential invasive to noninvasive ventilation group. Results： The invasive ventilation period and length of stay in ICU of the observed group were significantly shorter than that of control group （P〈0.05）. Incidence of VAP and reintubation rates were lower in observation group than that in control group （P〈 0. 05）. After all cases received noninvasive ventilation, the difference in pH, PaO2, PaCOz, PaO2/FiOz ,heart rate, and SBP in observeation group were not significant （P：〉0.05）. Conclusion： Se- quential invasive to noninvasive ventilation is better than that of invasive ventilation for COPD with acute exacerbation resulting from severe respiratory failure, as it can effectively decreasing the invasive ventilation period, reduce the incidence of VAP and improve the patients＇ prognosis.