有创-无创序贯通气在COPDⅡ型呼吸衰竭中的应用临床观察

Clinical Observation of Sequential Invasive to Noninvasive Ventilation on Treatment of Ⅱ-type Respiratory Failure Due to Chronic Obstructive Pulmonary Disease

目的:探索有创-无创序贯通气法对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的应用疗效。方法:选择COPDⅡ型呼吸衰竭需机械通气的患者77例,随机分为序贯组35例,常规组32例,所有患者均接受气管插管及机械通气,待肺部感染控制(PIC)窗出现后,选择无创呼吸机模式(BiPAP),常规组则保持机械通气至脱机。观察两组的主要指标并记录序贯组拔管时和BiPAP治疗4 h后的血气变化。结果:序贯组的有创通气时间为(73.58±30.17)h、气管插管复插率为5.7%和VAP发生率为2.9%,均显著低于常规组,差异有统计学意义(均P=0.000),两组总机械通气时间以及呼吸重症监护病房(RICU)住院时间的差异近似,无统计学意义(总机械通气时间:P=0.958;RICU住院时间:P=0.654)。序贯组在选择BiPAP后,pH、血氧分压(PaO2)、二氧化碳分压(PaCO2)、心率(HR)和平均动脉压(MAP)值与拔管时的差异均近似,差异无统计学意义(均P>0.05)。结论:有创-无创序贯通气可明显缩短机械通气时间,降低气管插管复插率及VAP发生率,结合有效的护理措施能够有效改善COPD合并Ⅱ型呼吸衰竭。

Objective： To explore the efficacy of the application of sequential invasive to noninvasive ventilation on treatment of Ⅱ -type respiratory failure due to chronic obstructive pulmonary disease （COPD）. Methods： 77 patients with COPD Ⅱ -type respiratory failure requiring mechanical ventilation were randomly divided into the sequential group （n=35）, and the conventional group （n=32）. All patients underwent endotracheal intubation and mechanical ventilation. The conventional group chose a non-invasive ventilator mode （BiPAP） until the pulmonary infection control （PIC） the window appeared. Meanwhile, the conventional group chose maintained mechanical ventilation to the end. The main indicators of the two groups were observed and the blood gas changes between extubation and 4h BiPAP treatment in the sequential group were recorded. Results： In the sequential group, the invasive ventilation was （73.58± 30.17） h, the re-interpolation rate was 5.7 percent and the incidence of VAP was 2.9%. All of them were significantly lower than those in the conventional group. The differences were statistically significant （all P = 0.000）. The differences of total mechanical ventilation duration and R/CU hospitalization time in the two groups were similar. The differences were not statistical significant （total mechanical ventilation duration： P=0.958; RICU hospitalization time： P=0.654）. After BiPAP was applied in the sequential group, the differences in pH, PaO2, PaCO2, HR and MAP were similar with those in extubation period. The differences were not statistically sisnificant （all P〉 0.05）. Conclusion： Sequential invasive to noninvasive ventilation can significantly shorten the duration of mechanical ventilation, reduce the re-interpolation rate, and the incidence of VAP. It can improve Ⅱ-type respiratory failure due to COPD when combined with effective nursing care.