慢性阻塞性肺疾病急性发作伴Ⅱ型呼吸衰竭合并急性左心衰竭撤机的研究

Withdrawing mechanical ventilation in acute exacerbation and type Ⅱrespiratory failure in chronic obstructive pulmonary disease with acute heart failure

目的探讨慢性阻塞性肺病急性发作(AECOPD)伴Ⅱ型呼吸衰竭合并急性左心衰竭撤机的不同方法。方法选择AECOPD伴Ⅱ型呼吸衰竭同时合并急性左心衰竭需要有创呼吸机通气的患者42例,随机分为研究A组和研究B组,研究A组采用"以肺部感染控制窗"(PIC)为切换点行有创与无创序贯机械通气撤机方法,研究B组采用自主呼吸试验(SBT)成功后接有创-无创序贯撤机方法。观察两组有创通气时间、48小时再插管率、呼吸机相关性肺炎(VAP)发生率、住重症监护病房(ICU)时间、病死率、总通气时间和住院时间。结果两组有创通气时间、48小时再插管率、VAP发生率、住ICU时间和病死率方面比较差异均无统计学意义(P>0.05);研究A组在总通气时间,住院时间较研究B组延长(P<0.05)。结论以"PIC"窗为切换点行有创与无创序贯机械通气撤机与采用SBT有创-无创序贯撤机相比并未获益,且总机械通气时间、住院时间延长。

Objective To investigate the different methods of withdrawing mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease（AECOPD）with typeⅡrespiratory failure and acute heart failure（HF）.Methods A prospective,randomized,double-blinded tudy was performed in 42 AECOPD patients with typeⅡrespiratory failure and HF suffering from mechanical ventilation,and the patients were randomly divided into two groups,including 20 cases in study group A and 22 cases in study group B.The patients in study group A got early extubation and sequential noninvasive mechanical ventilation switched by pulmonary infection control window（PIC window）,while those in study group B after spontaneous breathing trial（SBT）had immediate extubation and received sequential noninvasive mechanical ventilation.The duration of invasive mechanical ventilation,48hour-intubation rate,the duration of ICU stay,the total duration of ventilatory,in-hospital mortality,rate of ventilator-associated pneumonia（VAP）and the duration of hospital stay were compared between two groups.Results The duration of invasive mechanical ventilation,48hour-intubation rate,the duration of ICU stay,in-hospital mortality and rate of ventilatorassociated pneumonia（VAP）were not significantly different between two groups（P〉0.05）.The total duration of ventilatory（t=2.135,P =0.039）and the duration of hospital stay（t =2.098,P =0.042）were significantly different between two groups（P〈0.05）.Conclusion The comparison showed no benefit for PIC window at withdrawing sequential noninvasive and invasive mechanical ventilation with SBT＇s sequential noninvasive and invasive mechanical ventilation.The total duration of ventilation and the duration of hospital stay in study group A were longer in study group B.