短期有创序贯无创面罩机械通气在慢性阻塞性肺疾病危重呼吸衰竭治疗中的应用

Applicable study of sequential non-invasive following short-term invasive mechanical ventilation in COPD patients with severe respiratory failure

目的 评价短期有创提前拔管序贯无创面罩机械通气治疗COPD危重呼吸衰竭的价值。方法 2 4例COPD危重呼吸衰竭气管插管机械通气患者 ,在达到“提前拔管指征”后拔除插管序贯无创面罩机械通气 ,设为序贯组 ;30例相同病情持续留置气管插管至脱机患者为对照组。结果 序贯组气管插管后 1h动脉血pH、PaCO2 均已开始改善 ,P <0 0 1;血氧达到机体氧合需求 ;2 4h后血气继续改善 ,P <0 0 0 1。 41 7%于 3d ,其余 7d内达到“提前拔管指征”序贯无创面罩通气。序贯治疗后 ,血气改善情况继续保持 ,P >0 0 5。 75 0 %于 5d内 ,其余 12d内顺利完成撤机 ,成功率 10 0 %。与对照组比较 :有创通气时间分别为 3 8± 1 2d和 18 6± 9 4d ,P <0 0 0 1;总机械通气时间为 9 3± 3 7d和 18 6± 9 4d ,P <0 0 0 1;VAP发生例数为 1例和 9例 ,P <0 0 5 ;RICU住院时间为 12 3± 5 3d和 2 8 6± 8 4d ,P <0 0 0 1;住院总费用为 1 7± 0 5和 3 8± 1 1万元 ,P <0 0 0 1;治愈率为 91 7%和 70 0 % ,P <0 0 5。结论 短期有创提前拔管序贯无创面罩机械通气在COPD危重呼吸衰竭治疗中疗效显著 ,优点多 ,临床值得推广。

Objective To discuss the value of sequential non-invasive following short-term invasive mechanical ventilation(MV) in COPD patients with severe respiratory failure.Methods 24 intubated MV COPD cases with severe respiratory failure were involved in the study.At the time the “advance extubated clinical symptoms”had been achieved,the early extubation was conducted and followed by non-invasive MV via facial mask immediately (study group).Other 30 COPD cases with similar conditions continuously received invasive MV by the time they weaned from ventilation(control group).Results In study group,pH and PaCO 2 or PaO 2 were significantly get better in an hour( P <0 01),and more better in 24 hours( P <0 001).According to“advance extubated clinical symptoms”,there were 41 7% cases successfully extubated in 3days,and 58 3% cases in 7 days.After the non-invasive MV was conducted,the improvement of pH and PaCO 2 or PaO 2 remained.There were 75% cases successfully weaned from ventilation in 5 days,and 25% cases in 12 days.With two groups,the duration of invasive MV was 3 8±1 2 days vs 18 6±9 4 days, P <0 001;the total duration of ventilatory support was 9.3±3.7 days vs 18.6±9.4 days, P <0 001;the incidence of VAP was 1/24 vs 9/30, P <0 05;the hospitalization in RICU was 12 3±5 3 days vs 28 6±8 4 days, P <0 001;the total hospital consumption was 1 7±0 5 vs 3 8±1 1 ten thousand yuan, P <0 001;the rate of healing was 91 7% vs 70 0%, P <0 05.Conclusion Sequential non-invasive following short-term invasive mechanical ventilation(MV) in COPD patients with severe respiratory failure was available.It was worthy to be generally applied.