有创-无创序贯机械通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的可行性分析

The feasibility of sequential invasive- noninvasive mechanical ventilation in treating acute exacerbation of chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure

目的探讨有创-无创序贯机械通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的可行性。方法选择2011年4月至2014年4月我院收治的100例慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者作为研究对象,随机分为研究组和对照组各50例,两组患者均给予基础治疗,在此基础上对照组加用有创机械通气治疗,研究组加用有创-无创序贯机械通气治疗,比较两组患者血气指标和住院指标。结果两组患者治疗后pH和PaO2明显增高,但组间比较差异无统计学意义(P>0.05)。两组患者治疗后PaCO2均明显降低,但组间比较差异无统计学意义(P>0.05)。研究组住院时间和机械通气时间较对照组低,呼吸机相关性肺炎发生率也较对照组低,差异均有统计学意义(P<0.05)。结论合并Ⅱ型呼吸衰竭的急性加重期慢性阻塞性肺疾病应用有创-无创序贯机械通气治疗可取得良好治疗效果,且能有效缩短住院时间和机械通气时间,降低并发症发生率。

Objective To evaluate the feasibility of sequential invasive -noninvasive mechanical ventilation in treating acute exacerbation chronic obstructive pulmonary disease complicated with type Ⅱrespiratory failure .Methods 100 cases of acute exacerbation chronic obstructive pulmonary disease complicated with typeⅡrespiratory failure from April 2011 to April 2014 in our hospital were chosen as experimental objects , and they were divided into control group and experimental group , patients in both two groups were treated with routine treatments , and then patients in control group were treated with invasive mechanical ventilation except the routine treatments , however , patients in experimental group were treated with sequential invasive -noninvasive mechanical ventilation , the blood gas indexes and hospitalization index of the two groups were compared . Results PH and PaO2 of both two group were increased comparing with before , but there were no significant difference between the two groups （P〉0.05）.PaCO2 of two group were decreased comparing with before , but there were no significant difference between the two groups （P〉0.05）.The time of hospitalization and length of mechanical ventilation of experimental group were lower than that of control group , and the incidence of ventilator-associated pneumonia was lower than that of control group , the differences were statistically significant （P〈0. 05）.Conclusions Sequential invasive -noninvasive mechanical ventilation has good effects on acute exacerbation chronic obstructive pulmonary disease complicated with type Ⅱrespiratory failure , and could shorten the time of hospitalization and length of mechanical ventilation , decrease the incidence of ventilator -associated pneumonia .