有创-无创序贯机械通气治疗慢性阻塞性肺疾病并呼吸衰竭的效果观察

Invasive and non-invasive sequential mechanical ventilation in patients with chronic obstructive pulmonary disease with respiratory failure effect observation

目的观察有创-无创序贯机械通气治疗慢性阻塞性肺疾病并呼吸衰竭的临床疗效。方法选取慢性阻塞性肺疾病急性加重期并呼吸衰竭患者58例,随机分为两组,每组29例,分别给予持续有创机械通气(对照组)治疗及有创-无创"序贯"机械通气(治疗组)治疗。分析并比较两组患者机械通气前APACHEⅡ评分、血气分析、有创机械通气时间、总机械通气时间、总住院时间。结果治疗组与对照组比较,两者在治疗后呼吸频率、心率、动脉血气值上较治疗前均有明显好转,且两组比较差异无统计学意义(P>0.05)。治疗组APACHEⅡ评分、PaO2/FiO2、PaCO2、并发症、死亡例数、机械通气时间及住院时间明显低于对照组,差异有统计学意义(P<0.05)。结论有创机械通气是治疗COPD合并呼吸衰竭的有效方法,采用这种序贯机械通气方法的关键是及时、准确地把握肺部感染控制窗,正确操作无创性机械通气。

Objective To observe the invasive and non-invasive sequential mechanical ventilation in patients with chronic obstruc- tive pulmonary disease and respiratory failure clinical curative effect. Methods 58 patients with chronic obstructive pulmonary diseases in acute exacerbation period and respiratory failure were randomly divided into two groups. There were 29 cases each group. The patients were given respectively continuous invasive mechanical ventilation therapy （ control group） and invasive-- noninvasive ＂sequential me- chanical ventilation therapy （ treatment group）. Prior to analysis and compare the two groups of patients with mechanical ventilation A- PACHE ]] score, blood gas analysis, invasive mechanical ventilation time and total time of mechanical ventilation, total length of hos- pital stay. Results Treatment group compared with control group, both in the respiratory frequency and heart rate, arterial blood gas values after treatment than before treatment were obviously improved, and the more similar between the two groups has no statistical sig- nificance （ P〉0. 05 ）. Treatment group APACHE 1] score, PaOz/ Fi02, PaCO2, complications, death cases, mechanical ventilation time and hospitalization time significantly were lower than the control group. The difference was statistically significant （ P〈0. 05 ）. Con- clusion Invasive mechanical ventilation is an effective method in treatment of combination of respiratory failure of COPD. Adoptting this method of sequential mechanical ventilation is the key to timely, accurately grasp the pulmonary infection control window, noninva- sive mechanical ventilation operation correctly.