有创-无创序贯性机械通气在中枢性呼吸衰竭中的临床应用

目的探讨保留气切导管的有创-无创序贯性机械通气在中枢性呼吸衰竭中的临床应用效果。方法对中枢性呼吸衰竭行机械通气的患者共540例进行回顾性分析,其中行常规有创-无创序贯性机械通气的患者240例为对照组,行保留气切导管的有创-无创序贯性机械通气的患者300例为试验组,比较2组患者呼吸机相关性肺炎发生率、机械通气时间、再次气管插管发生率、ICU住院时间、住院病死率和保留气切导管并发症等指标。结果 2组患者的呼吸机相关性肺炎发生率(55%vs 66.7%)、机械通气时间[(12.40±2.93)d vs(15.63±5.18)d]、再次气管插管发生率(1.3%vs7.9%)和ICU住院时间[(16.47±5.01)d vs(20.79±5.54)d],差异均有统计学意义(P<0.05),但住院病死率(49%vs 55%)和长时间保留气切导管并发症发生率差异无统计学意义。结论保留气切导管的有创-无创序贯性机械通气能降低呼吸机相关性肺炎、再次气管插管等并发症的发生率,减少机械通气时间和ICU住院时间,但对病死率没有明显影响。

Objective To investigate the feasibility and the efficacy of sequential non-invasive following short-term invasive mechanical ventilation in central respiratory failure with preservation of catheter for tracheotomy.Methods The clinical data from 540 patients with central respiratory failure enterring to ICU of the second afifliated hospital, University of South China from June 2008 to June 2013 were retrospectively analyzed. 240 patients with conventional sequential non-invasive following short-term invasive mechanical ventilation were selected as contol group, and 300 patients with sequential non-invasive fowllowing invasive mechanical ventilation with preservation of catheter for tracheotomy were as experimental group. Ventilator- associated pneumonia （VAP） incidence, re-intubation rate and mechanical ventilation time, ICU stay time, the in-hospital mortality and complication of preservation of catheter were analysized.Results The VAP incidence （55%）, re-intubation rate （1.3%）, mechanical ventilation time （12.40±2.93） d and ICU stay time （16.47±5.01） d of exeprimental group were signiifcantly lower than those of control group （P〈0.05）. However, the in-hospital mortality （49%） and complication of preservation of catheter of experimental group was not signiifcantly different between the two groups.Conclusion The sequential non-invasive following short-term invasive mechanical ventilation with preservation of catheter can decrease the VAP incidence, re- intubation rate, mechanical ventilation time and ICU stay time for the patients of central respiratory failure, while not affecting with in-hospital mortality.