慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者经有创-无创序贯机械通气治疗的临床分析

Clinical Analysis on Invasive-noninvasive Sequential Mechanical Ventilation in the Treatment of Chronic Obstructive Pulmonary Disease Complicated by Type Ⅱ Respiratory Failure

目的观察慢性阻塞性肺疾病(慢阻肺)合并Ⅱ型呼吸衰竭患者经有创-无创序贯机械通气治疗的临床效果。方法选取2013年3月-2014年4月100例慢阻肺合并Ⅱ型呼吸衰竭患者,采用随机数字表法分为对照组和研究组,每组各50例。对照组给予持续有创通气治疗,研究组采取有创-无创序贯通气治疗。观察两组机械通气时间、入住重症监护病房(ICU)时间、住院时间、治疗前后血清C反应蛋白(CRP)浓度、呼吸机相关性肺炎(VAP)发生率和院内病死率。结果研究组患者入住ICU时间、机械通气时间和住院时间分别为(9.4±8.1)、(10.3±5.8)、(14.7±8.2)d,明显短于对照组的(17.5±10.8)、(15.2±7.7)、(22.8±7.4)d,组间比较差异有统计学意义(P<0.05);研究组患者VAP发生率和院内因VAP病死率分别为4.0%、2.0%,明显低于对照组的22.0%、20.0%,组间比较差异有统计学意义(P<0.05)。结论在慢阻肺合并Ⅱ型呼吸衰竭患者的临床治疗方案中,有创-无创序贯通气治疗方案效果确切,有利于缩短机械通气时间和住院时间,可控制VAP发病率,降低病死率,值得临床推广。

Objective To observe the clinical efficacy of invasive-noninvasive sequential mechanical ventilation in the treatment of chronic obstructive pulmonary disease（COPD） complicated by type Ⅱ respiratory failure.Methods A total of 100 patients with COPD complicated with type Ⅱ respiratory failure from March 2013 to April 2014 were randomly divided into control group and study group（with 50 patients in each）.While the control group was given continuous invasive ventilation treatment,the study group was treated with invasive-noninvasive sequential ventilation.The ventilation time,Intensive Care Unit（ICU） monitoring and hospitalization time,the serum concentrations of C-reactioin protein（CRP） before and after treatment and the ventilator associated pneumonia（VAP） and hospital mortality rate were observed and compared between the two groups.Results For patients in the study group,ICU monitoring time,ventilation time and hospitalization time were（9.4±8.1）,（10.3±5.8）,and（14.7±8.2） days,respectively,significantly shorter than those in the control group[（17.5±10.8）,（15.2±7.7）,and（22.8±7.4） days]（P〈 0.05）.The incidence of VAP and nosocomial VAP mortality in the study group were 4.0%and 2.0%respectively,which were significantly lower than those in the control group（22.0%and 20.0%）,and the differences were statistically significant（P〈 0.05）.Conclusion In the clinical treatment of COPD patients with type Ⅱ respiratory failure,invasivenoninvasive sequential ventilation treatment is effective in shortening the duration of ventilation and hospitalization time,controlling the incidence of VAP,and reducing the mortality rate,which is worthy of clinical popularization.