有创-无创序贯机械通气在慢阻肺疾病Ⅱ型呼衰患者中的应用价值

Application of noninvasive-invasive sequential mechanical ventilation in treatment of COPD patients complicated with type Ⅱ respiratory failure

目的观察有创-无创序贯机械通气在慢性阻塞性肺疾病Ⅱ型呼衰患者中的应用价值。方法选择慢阻肺疾病伴Ⅱ型呼衰需机械通气患者44例,所有患者均给予抗感染、化痰、平喘、舒张气道等对症处理,给予有创机械通气,通气模式为SIMV,临床判断为肺部感染控制窗(PIC)时,前瞻性随机分为序贯组和对照组治疗。序贯组为判断达到PIC窗撤机标准后拔出气管插管,改用无创正压机械通气(NPPV),全部为双水平正压通气(BiPAP)模式,后逐渐缩短无创机械通气时间,并最终停止无创机械通气。对照组继续传统IPPV呼吸支持,目前最常用脱机模式为压力支持模式脱机。结果有创-无创序贯治疗组与对照组相比,住院时间、总通气时间、再插管例数、VAP发生例数、死亡人数和住院费用差别有统计学意义(P<0.05)。结论有创-无创序贯通气可有效治疗慢阻肺合并Ⅱ型呼衰,可减少住院时间、VAP发生率、再插管率及住院费用,减轻患者经济压力。

Objective To observe the application value of noninvasive-invasive sequential mechanical venti- lation in treatment of COPD patients complicated with type II respiratory failure. Methods 44 COPD patients com- plicated with respiratory failure requiring mechanical ventilation were chosen in this study. All patients were given an- ti-infection, phlegm resolving, asthma relieving, relaxation of airway and other symptomatic treatment, and SIMV mode of invasive mechanical ventilation. When the clinical judgment was pulmonary infection control window （ PIC）, it was randomly divided into the sequential group and the control group prospectively. For the sequential group, while reaching PIC window weaning criteria, the tracheal intubation was pull out and noninvasive positive pressure ventila- tion （NPP~） was applied, all with bilevel positive pressure ventilation （BiPAP）, and then the time of noninvasive mechanical ventilation was gradually shortened, and eventually stopped. For the control group, it continued tradition- al IPPV respiratory support and used pressure support mode to wean, which was the most commonly used weaning mode at present. Results There were significant differences in duration of hospital stay, duration of ventilation, number of cases of VAP, number of death cases and hospital cost between the invasive-noninvasive sequential therapy group and the control group （P 〈 0. 05）. Conclusion Invasive and non-invasive sequential ventilation can effective- ly treat COPD with respiratory failure, reduce the duration of hospital stay, the incidence of VAP, re intubation rate and hospital cost.