有创-无创序贯通气在AECOPD合并肺性脑病患者呼吸机撤机中的研究分析

The Study of Invasive-noninvasive Sequential Ventilation in Ventilator Weaning for AECOPD Patients Complicated with Pulmonary Encephalopathy

目的:探讨有创-无创序贯通气在慢性阻塞性肺疾病急性加重期(AECOPD)合并肺性脑病患者呼吸机撤机中的价值。方法:选取2013年1月-2015年12月在本院住院行机械通气的40例慢性阻塞性肺疾病急性加重期(AECOPD)合并肺性脑病的患者。当AECOPD合并肺性脑病行机械通气的患者出现肺部感染控制窗(PIC窗)时,将患者随机分为序贯通气组和对照组,各20例。序贯通气组拔管实施BiPAP机无创通气,对照组继续实施SIMV+PSV模式机械通气,SIMV+PSV模式下撤机。比较两组患者在肺部感染控制窗(PIC窗)前后血气分析变化,同时比较两组患者有创通气时间、呼吸机相关性肺炎(VAP)发生率、死亡率、总通气时间。结果:序贯通气组的有创通气时间、总通气时间、VAP发生率、死亡率均少于对照组,差异均有统计学意义(P<0.05)。两组的血气指标在PIC窗撤机前与PIC窗撤机24 h后比较,差异均无统计学意义(P>0.05)。结论:对AECOPD合并肺性脑病患者呼吸机撤机,选用有创-无创序贯通气撤机优于SIMV+PSV机械通气常规撤机模式,有创-无创序贯通气对AECOPD合并肺性脑病患者是一种行之有效的脱机方法。

Objective：To explore the value of invasive-noninvasive sequential ventilation in ventilator weaning for patients with AECEPD complicated with pulmonary encephalopathy.Method：40 patients with AECOPD complicated with pulmonary encephalopathy under mechanical ventilation in our hospital from January 2013 to December 2015 were selected,when AECOPD patients with pulmonary encephalopathy underwent mechanical ventilation,appeared pulmonary infection control window（PIC window）,the patients were divided into sequential ventilation group and control group randomly,20 cases in each group.The sequential ventilation group extubation was performed by Bi PAP machine,while the control group continued to implement SIMV＋PSV mode mechanical ventilation,and the SIMV＋PSV model was used to remove the ventilator.The changes of blood gas analysis were compared between the two groups before and after pulmonary infection control window（PIC window）,at the same time,the invasive ventilation time,the incidence of ventilator-associated pneumonia（VAP） mortality,total ventilation time of two groups were compared.Result：The time of invasive ventilation,total ventilation time,VAP incidence and mortality rate of the sequential ventilation group were less than the control group,the differences were statistically significant（P〈0.05）.The blood gas indexes of two groups were compared before PIC window and after the removal of with PIC window for 24 h,there were no statistically significant differences（P〈0.05）.Conclusion：The AECOPD patients with ventilator withdrawal of pulmonary encephalopathy,using sequential invasive noninvasive ventilation is better than conventional weaning from mechanical ventilation in SIMV＋PSV model,sequential invasive noninvasive ventilation on AECOPD patients with pulmonary encephalopathy is a kind of effective off-line method.