有创-无创序贯撤机策略在COPD撤机困难患者中的应用

Application of strategy of sequential invasive-noninvasive mechanical ventilation in COPD patients with weaning difficulty

目的探讨有创-无创序贯撤机策略在慢性阻塞性肺病（COPD）机械通气撤机困难患者中作用。方法选择2009年1月至2013年12月期间辽宁省葫芦岛市中心医院急诊科监护室慢性阻塞性肺病机械通气撤机困难患者45例,比较有创-无创序贯撤机（干预组,n=21）与撤机拔管后立即给予鼻导管给氧（对照组,n=24）两组间撤机后动脉血气（p H、Pa CO2）、48 h再气管插管率、撤机成功率。结果干预组撤机拔管24 h后p H、Pa CO2明显优于对照组（P〈0.01）;干预组48 h再气管插管率为9.5%,低于对照组41.7%（P〈0.05）,干预组再插管相对危险度0.147（95%CI,0.028~0.781）。干预组撤机成功率明显高于对照组（85.7%vs 50.0%,P〈0.05）。结论撤机困难COPD患者有创-无创序贯撤机策略有助于降低48 h再气管插管率和提高撤机成功率。

Objective To study the strategy of sequential invasive-noninvasive mechanical ventilation in chronic obstructive pulmonary disease（ COPD） and specially to explore the role of mechanical ventilation in patients with weaning difficulty. Methods Forty-five cases withe weaning difficulty during January 2009 - December 2013 from Huludao central hospital emergency section guardianship room were recruited. Compare the rate of re-tracheal intubation rate and withdrawal machine success rate in two groups（ intervention group,n = 21,control group,n = 24）.Results In the intervention group after weaning the 24 h p H,Pa CO2 was significantly better than that of the control group（ P 〈0. 01）,in the endotracheal intubation intervention group,48 h re-tracheal intubation rate was 9. 5%,less than the control group（ 41. 7%）（ P〈 0. 05）,The relative risk of intervention group was 0. 147（ 95% CI,0. 028 - 0. 781）. Intervention weaning success rate is significantly higher than that of the control group（ 85. 7% vs50. 0%,P 〈0. 05）. Conclusions Sequential invasive-noninvasive mechanical ventilation strategy reduces 48 h intubation rate and improve the success rate of weaning.