序贯通气治疗老年重症肺心病合并呼吸衰竭的疗效分析

Clinical analysis of sequential mechanical ventilation in treatment of elderly patients with severe pulmonary heart disease complicated with respiratory failure

目的探讨有创与无创序贯性机械通气治疗老年重症肺心病合并Ⅱ型呼吸衰竭的方法与疗效。方法对66例老年重症肺心病合并Ⅱ型呼吸衰竭患者进行气管插管后机械通气。肺部感染控制窗(PIC窗)出现后,将患者均分为两组,序贯组给予拔除气管插管改无创机械通气,对照组继续有创机械通气。对比观察两组患者病情变化、血气分析、机械通气时间、呼吸机相关肺炎(VAP)发生情况、入住呼吸ICU(RICU)时间、死亡情况等。结果序贯组无创通气后24小时两组临床指标比较差异无统计学意义(P>0.05),但机械通气时间、VAP发生率、入住RICU时间比较差异均有统计学意义(P<0.05)。结论①对老年重症肺心病合并慢性呼吸衰竭急性加重期患者,应尽早给予有创通气。②序贯性机械通气可降低老年重症肺心病合并Ⅱ型呼吸衰竭患者VAP发生率及死亡率,缩短机械通气时间和住院时间。③以PIC窗为时机早期拔管,改用无创通气可以显著改善治疗效果。

Objective To explore the techniques and efficacy of sequential invasive and non-invasive mechanical ventilation in treatment of elderly patients with pulmonary heart disease （PHD） complicated with respiratory failure. Methods Sixty-six elderly patients with severe PHD complicated with type-Ⅱ respiratory failure were involved and given mechanical ventilation therapy. The pa- tients were randomly and evenly divided into study and control groups when the pulmonary infection control window（ PIC window）ap- peared. The study group were extubated and given sequential noninvasive mechanical ventilation, while the control group were continu- ously given invasive mechanical ventilation. Clinical characteristics, blood gas analysis,total duration of mechanical ventilation support, incidence of VAP, duration of iCU stay and mortality were observed and compared-between the two groups. Results There was no sig- nificant difference in clinical characteristics and gas exchange at the short-time treatment between the two groups. However, the total duration of mechanical ventilation support, the risk of VAP and the duration of ICU stay in the study group were more pronounced than that in the control group（ P 〈 0.05 ）. Conclusions ①For elderly patients with severe PHD complicated with type-Ⅱ respiratory fail- ure during acute aggravating period, invasive mechanical ventilation should be given as soon as possible. ②Sequential mechanical venti- lation may significantly decrease the total duration of mechanical ventilation support, the risk of VAP and the duration of ICU stay. ③ Noninvasive ventilation support which be initiated at the point of PIC window can significantly improve the efficacy of treatment.