无创正压通气在慢性阻塞性肺疾病所致严重呼吸衰竭机械通气脱机过程中的应用

The Application of Noninvasive Positive Pressure Ventilation in COPD Caused by Severe Respiratory Failure Mechanical Ventilation of

目的:深入研究无创正压通气在慢性阻塞性肺疾病(COPD)所致严重呼吸衰竭机械通气脱机过程中的应用价值。方法:治疗组:36例COPD合并严重呼吸衰竭患者入院后均需使用有创机械通气,模式PSV+SIMV;待患者肺部感染控制窗出现,PSV水平降至11-12cmH2O之间,拔出COPD患者气管内插管,然后改用无创正压通气(NIPPV),按照患者呼吸频率改变PSV水平,待病情平稳后可继续降低PSV水平,在9cmH2O后可停用呼吸机。观察组:36例COPD合并严重呼吸衰竭患者入院后均需进行有创机械通气进行治疗,待患者病情平稳,按照PSV方式脱机,PSV水平降低至5-8cmH2O时,进行拔管脱机。结果:治疗组患者住院时间和,总通气时间明显短于观察组,且VAP发生率明显低于观察组。结论:NIPPV可有效提高COPD患者严重呼吸衰竭机械通气脱机撤机成功率,缩短患者机械通气时间和住院时间,有利于降低患者VAP发生率和病死率。

Objective： To study the application value of noninvasive positive pressure ventilation in chronic obstructive pulmonary disease caused by severe respiratory failure mechanical ventilation. Method： The treatment group ： 36 cases of COPD with severe respiratory failure after the required use of invasive mechanical ventilation, PSV＋SIMV stay patients ; pulmonary infection control window appears, the level of PSV decreased to 11 cmH20-12cmH20, pulling out the tracheal intubation in patients with COPD, then with noninvasive positive pressure ventilation （ NIPPV ） , according to patients with respiratory frequency change the level of PSV, to be stable condition can continue to reduce the level of PSV, 9emilzO stopped ventilator. The observation group： 36 cases of COPD with severe respirat-.ry failure after rquired for invasive mechanical ventilation treatment, the patients with stable disease, according to PSV, PSV levels decreased to 5- 8cmH20, offline for extubation. Result： The patients in treatment group hospitalization time and total ventilation time was significantly shorter than those in the observation group, and the incidence rate of VAP was significantly lower than the observation group. Conclusion：NIPPV can effectively improve the COPD patients with severe respiratory failure mechanical ventilation weaning success rate, shorten the duration of mechani- cal ventilation and hospitalization time of patients, reduce the incidence of VAP and patients