慢性阻塞性肺疾病急性加重患者行序贯机械通气的切换时机分析

Analysis of The Timing of Sequential Mechanical Ventilation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的研究以肺部感染控制窗(PIC)联合改良格拉斯哥昏迷指数(GCS)评分在慢性阻塞性肺疾病急性加重(AECOPD)患者行序贯通气有创-无创切换治疗中的疗效,并进行评价分析。方法选取我院2012年1月至2015年6月收治的182例(AECOPD)患者,采用有创-无创序贯机械通气治疗,随机分为研究组和对照组两组,研究组切换时机为出现PIC窗,且改良GCS评分达到15分并稳定2h;对照组切换时机为出现PIC窗。比较两组患者VAP发生率、气管插管保留时间、有创通气总时间、总机械通气时间、入住ICU时间、再次插管率以及死亡率等指标。结果研究组的ICU住院时间、机械通气总时间小于对照组,再次插管率低于对照组,差异均有统计学意义(P<0.05)。研究组的VAP发生率和死亡率和对照组差异并不显著(P>0.05)。结论 PIC窗联合GCS评分达到15分并稳定2 h作为AECOPD患者序贯通气的切换标准可降低再次插管率、机械通气总时间以及ICU住院时间,具有重要临床意义。

Objective Research with pulmonary infection control window （PIC）combined with modified Glasgow Coma Scale （GCS）score in acute exacerbation of chronic obstructive pulmonary disease（AECOPD）were treated with sequential mechanical ven-tilation with noninvasive a switch in the treatment efficacy and evaluation and analysis.Methods Selected in our hospital in Jan-uary 2012 to June 2015 treated 182 cases of chronic obstructive pulmonary disease acute exacerbation（AECOPD） patients with in-vasive noninvasive sequential mechanical ventilation in the treatment,were randomly divided into two research group and the control group two groups,the team switch timing for a pulmonary infection control window （PIC） modified Glasgow coma scale （GCS） is a group of 15 points and stabilize 2 h,the control switch timing for pulmonary infection control window （PIC）.The incidence rate of VAP,the retention time of endotracheal intubation,total time of invasive ventilation,total mechanical ventilation time,ICU time,re intubation rate and mortality rate were compared between the two groups.Results Research group ICU length of time and the total duration of mechanical ventilation is smaller than control group,and significant difference （P〈0.05）,reintubation rate was far less than the control group,also have significant differences （P〈0.05）,but two groups of patients with VAP occurred rate and mortality difference was not significant （P〉0.05）.Conclusion Pulmonary infection control window （PIC） window combined with modified Glasgow Coma Scale（GCS） score group reached 15 points and stable 2h in COPD acute exacerbation（AECOPD）with the switching of sequential ventilation can reduce reintubation rate and total duration of mechanical ventilation and ICU stay and have important clinical significance,it is worth of clinical application.