不同方法治疗慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭疗效比较

Efficacy comparison of different methods in treating COPD complicating type Ⅱ respiratory failure

目的探讨有创-无创序贯通气策略对慢性阻塞性肺疾病(COPD)并发Ⅱ型呼吸衰竭的疗效。方法选择2010年1月至2012年12月收治的48例COPD并发Ⅱ型呼吸衰竭为研究对象,遵循随机自愿的原则分为观察组和对照组各24例。观察组在综合治疗的基础上行有创-无创序贯通气策略;对照组在综合治疗的基础上给予无创双水平正压机械通气(BiPAP),观察两组疗效。结果治疗12 d后两组患者血气分析、心率及肺功能均有所改善,与治疗前比较,差异有统计学意义(P<0.05),除pH值和心率外,观察组其他各项指标比对照组改善更为明显(P<0.05)。观察组平均总通气时间(10.5±2.3)d,平均住院时间(15.7±4.8)d,呼吸机相关性肺炎(VAP)发生率(4.2%)均明显少于对照组(P<0.05),撤机成功率(91.7%)明显高于对照组(70.8%),两组再次插管率以及不良反应发生率大体相当(P>0.05)。结论有创-无创序贯通气策略用于COPD并发Ⅱ型呼吸衰竭的患者,在保证有创机械通气疗效、正确把握肺部感染控制窗的前提下及时将拔管改为无创BiPAP,在降低VAP发生率、缩短住院时间、提高撤机成功率方面优于孤立使用有创机械通气或BiPAP通气策略,值得临床进一步研究和推广。

Objective To investigate the efficacy of sequential invasive-noninvasive ventilation strategy for treating chronic obstructive pulmonary disease （COPD） complicating type Ⅱ respiratory failure. Methods 48 cases of COPD complicating type Ⅱ respiratory failure treated in this hospital.from January 2010 to December 2012 were selected as the research subjects and randomly divided into the observation group and the control group, 24 cases in each group. Based on the comprehensive treat- ment, the observation group was performed the sequential invasive-noninvasive ventilation strategy and the control group under went the bilevel positive airway pressure （BiPAP） ventilation. Then, the effieacies of the two groups were observed. Results After 12 d treatment, the analysis results of blood gas, heart rate and lung function in the two groups were improved compared with be- fore treatment （P〈0.05）, but the observation group was improved more obviously （P〈0.05）. The average total ventilation time （ 10.5±2.3 ） d, the mean hospital stay time （ 15.7 ±4.8 ） d, the incidence rate of ventilator-associated pneumonia （VAP, 4.2% ） in the obser- vation group were significantly less than those in the control group （P〈0.05） ;and the success rate of ventilator weaning was 91.7%, which was higher than the control group （70.8%）. However, the reintubation rate and the incidence rate of adverse reactions of the two groups were roughly equivalent（P〉0.05）. Conclusion In the premise of ensuring the effect of invasive mechanical ven- tilation and correctly grasping the pulmonary infection control window,during conducting the sequential invasive-noninvasive ventilation strategy for treating COPD complicating type Ⅱ respiratory failure,timely changing extubation to BiPAP noninvasive ventilation is superior to single use of invasive mechanical ventilation or BiPAP ventilation in the aspects of reducing the inci- dence rate of VAP, shortening the hospitalization time and increasing the success rate of ventilator weaning,which is worth for further study and clinical application.