降钙素原窗在AECOPD合并呼吸衰竭患者行有创-无创序贯通气中的应用

Application of PCT window for invasive-noninvasive sequential ventilation in treatment of AECOPD patients with respiratory failure

目的探讨"降钙素原窗(PCT窗)"在慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者行有创-无创序贯通气切换点选取中的应用价值。方法选取AECOPD合并Ⅱ型呼吸衰竭需有创通气治疗的患者48例,随机分为实验组25例,对照组23例。2组患者均插管有创机械通气,给予抗感染、糖皮质激素等综合治疗。出现PCT窗后,实验组及时拔管转为经口/鼻面罩行无创正压机械通气(NIPPV)。对照组以同步间歇强制通气(SIMV)+压力支持通气(PSV)模式逐步过渡到PSV模式继续有创通气。结果 2组患者病死率,脱机24 h后心率(HR)、呼吸频率(RR)及p H、动脉氧分压[p(O2)]、二氧化碳分压[p(CO2)],总通气时间、再插管次数及重症监护病房(ICU)留住时间差异无统计学意义(P>0.05)。实验组有创通气时间及发生呼吸机相关性肺炎(VAP)例数显著少于对照组(P<0.05或P<0.01)。结论以PCT窗作为AECOPD有创-无创序贯通气转换指标,可缩短有创通气时间、降低VAP发生率。

Objective To evaluate the value of procalcitonin window（ PCT window） for invasive-noninvasive sequential ventilation in treatment of chronic obstructive pulmonary disease（ AECOPD） patients with respiratory failure. Methods A total of 48 AECOPD patients with respiratory failure were randomly divided into study group（ n = 25） and control group（ n = 23）. Both groups received invasive ventilation,anti-infectious and glucocorticoid therapy. Nasal intermittent positive pressure ventilation（ NIPPV） was performed in the study group by PCT window,while synchronized intermittent mandatory ventilation（ SIMV） to pressure support ventilation（ PSV） were given gradually in the control group. Results There were no significant differences in mortality rate,heart rate at 24 hours after ventilator weaning,respiratory rate,p（ O2）,p（ CO2）,overall time of ventilation,incidence of secondary incubation and length of stay in ICU（ P〈0. 05）. The incidence of ventilator-associated pneumonia was significantly lower in the study group than that in the control group（ P〈0.05）,so was the time of invasive ventilation（ P〈0. 01）. Conclusion As an indicator in invasivenoninvasive sequential ventilation,PCT window can shorten the invasive venlitaion time and reduce incidence of VAP for AECOPD patients with respiratory failure