有创与无创序贯机械通气治疗COPD致严重呼吸衰竭的疗效观察

Clinical effect observation of sequential invasive and non-invasive mechanical ventilation in patients with COPD and respiratory failure

目的探讨有创与无创序贯机械通气治疗慢性阻塞性肺疾病(COPD)致严重呼吸衰竭的临床疗效。方法选取该院2012年10月至2015年9月收治的56例COPD合并Ⅱ型呼吸衰竭的患者分为对照组和观察组,各28例。对照组给予常规气管插管机械通气治疗,观察组给予有创与无创序贯机械通气治疗。同时,所有患者均给予抗感染、祛痰、解痉、营养支持等治疗。观察比较两组的动脉血气分析、机械通气时间、住院时间、呼吸机相关性肺炎(VAP)发生率、再插管率、死亡率及疗效等。结果两组患者治疗后,动脉血p H值、氧分压(Pa O2)和二氧化碳分压(Pa CO2)均有所改善;两组动脉血p H值比较,差异无统计学意义(P>0.05),而Pa O2和Pa CO2比较,差异均有统计学意义(P<0.01),观察组改善明显优于对照组;两组患者有创机械通气时间、住院总时间比较,差异均有统计学意义(P<0.01),观察组明显少于对照组;但总机械通气时间比较,差异无统计学意义(P>0.05);两组VAP发生率、再插管率及死亡率比较,差异均有统计学意义(P<0.05),观察组VAP发生率均低于对照组。结论有创与无创序贯机械通气治疗COPD致严重呼吸衰竭患者,能够有效改善患者呼吸功能、血气分析,缩短有创机械通气时间、降低VAP发生率、再插管率及死亡率,值得在临床推广应用。

Objective To explore the clinical effects of sequential invasive and non-invasive mechanical ventilation in patients with COPD and respiratory failure. Methods 56 cases were randomly divided into control group（28） and observation group （28）, control group accepted tracheal intubation ventilation, and observation group accepted sequential invasive and non-in- vasive mechanical ventilation. And all patients received anti-inflammatory, spasmolysis,oxygen and other supportive treatment. The arterial blood gas analysis, mechanical ventilation time, hospitalization time, total cost of hospitalization, incidence of VAP, re- intubation rate and mortality rate were observed and compared. Results The pH,PaO2 and PaCO2 were improved of both two groups after treatment; and the PaO2 and PaCO2 of observation group were significantly better than that of control group （P〈0.01） ; the mechanical ventilation time, hospitalization time, total cost of hospitalization of observation group were significantly less than that of control group （P〈0.01 ） ; there was no difference for the total ventilation time （P〉0.05） ; The incidence rate of VAP, reintubation rate and mortality rate were significantly lower than that of control group （P〈0.05）. Conclusions The method of se- quential invasive and non-invasive mechanical ventilation can effectively treat the patients with COPD and respiratory failure,it can improve the respiratory function, the blood gas, shorten the mechanical ventilation time, and reduce the incidence of VAP, reintubation rate and mortality, so it is worthy of clinical application.