96岁慢性阻塞性肺疾病合并呼吸衰竭患者成功脱机1例报道并文献复习

Weaning of a 96-year-old patient with chronic obstructive pulmonary disease complicated with respiratory failure: A case report and literature review

目的探讨高龄慢性阻塞性肺疾病患者机械通气后脱机的方法。方法报道我院2014年收治的1例96岁男性慢性阻塞性肺疾病患者合并呼吸衰竭的诊疗经过,并结合文献分析其成功脱机的经验。结果患者诊断为慢性阻塞性肺疾病,肺部感染,Ⅱ型呼吸衰竭,感染性休克。予以气管插管呼吸机辅助呼吸,通气模式为同步间歇指令通气,并给予升压、抗休克、抗感染及营养支持等治疗。于插管后第18天拔管,拔管后间断使用无创呼吸机辅助呼吸,通气模式为压力支持通气,并进行呼吸肌锻炼,最后顺利脱机。结论老年慢性阻塞性肺疾病患者全身情况差,机械通气后脱机相当困难,通过选用合适的通气模式,积极抗感染、营养支持及呼吸肌锻炼,可以成功脱机。

Objective To discuss the clinical characteristics of advanced aged patients with chronic obstructive pulmonary disease and the method of successful weaning after mechanical ventilation. Methods Clinical features and treatment of a 96-year-old male patient with chronic obstructive pulmonary disease complicated with respiratory failure in our hospital in 2014 were reviewed, and the experience of his successful weaning was analyzed. Results The 96 years old male patient who was diagnosed with chronic obstructive pulmonary disease, respiratory infection, typeⅡ respiratory failure and septic shock, was treated with mechanical ventilation, antibiotics, nutrition-support therapy and so on. The ventilation mode was synchronized intermittent mandatory ventilation. The patient was extubated successfully after 18 days of intubation. Then non-invasive ventilator was used intermittently and the function of respiratory muscles was trained until completely weaning. Conclusion Advanced aged patient with chronic obstructive pulmonary disease is characterized with worse conditions. Weaning is especially difficult after intubation to them. Appropriate ventilation mode, reasonable anti-infectious, nutrition-support therapy and respiratory muscle training will contribute to successful weaning at the right time.