不同时机下行有创机械通气治疗AECOPD合并重度呼吸衰竭的效果观察

Invasive mechanical ventilation in different times for AECOPD combined with severe respiratory failure

目的 观察不同时机下行有创机械通气治疗慢性阻塞性肺疾病急性加重（AECOPD）合并重度呼吸衰竭的效果.方法 选取2014年8月至2017年9月于本院接受治疗的AECOPD合并重度呼吸衰竭患者136例,采用随机数字表法将其分为观察组与对照组,各68例.观察组行早期（6h内）有创机械通气治疗,对照组行延迟（6h以后）有创机械通气治疗.对比两组血气指标变化情况、临床指标情况及并发症发生情况.结果 治疗后,两组PaCO2水平下降,PaO2、PaO2/FiO2水平上升,观察组上述指标改善情况较对照组优,差异具有统计学意义（均P＜ 0.05）;观察组有创机械通气时间（57.67±14.14）h,机械通气总时间（152.57±27.74）h,住ICU时间（6.71±1.36）d,均较对照组短,差异具有统计学意义（均P＜0.05）;观察组呼吸机相关性肺炎发生率较对照组低（10.29％比25.00％）,差异具有统计学意义（P＜0.05）.结论 AECOPD合并重度呼吸衰竭在明确有创机械通气的相关指征尽早行有创机械通气治疗可较好改善其血气指标,减少机械通气时间,促进患者恢复,且可降低相关并发症发生率,安全性较高.

Objective To observe the effect of invasive mechanical ventilation in different times for chronic obstructive pulmonary disease （AECOPD） combined with severe respiratory failure.Methods 136 patients with AECOPD combining severe respiratory failure treated at our hospital from August,2014 to September,2017 were selected,and were divided into an observation group and a control group by random number table method,68 cases for each group.The observation group were treated with invasive mechanical ventilation within 6 h and the control group after 6 h.The changes of blood gas indexes,clinical indicators,and complications were compared.Results The PaCO2 was lower and the PaO2 and PaO2/FiO2 were higher after than before the treatment in both groups,and they were in the observation group than in the control group after the treatment,with statistical differences （all P 〈 0.05）.The total invasive mechanical ventilation time,total mechanical ventilation time,and the ICU stay were （57.67±14.14） h,（152.57±27.74） h,and （6.71±1.36） d in the observation group,which were shorter than those in the control group,with statistical differences （all P 〈 0.05）.The incidence ventilator associated pneumonia was lower in the observation group than in the control group （10.29% vs.25.00%）,with a statistical difference （P 〈 0.05）.Conclusions Patients with AECOPD complicating severe respiratory failure and clear invasive mechanical ventilation related indications taking invasive mechanical ventilation therapy as early as possible can better improve their blood gas indexes and reduce mechanical ventilation time and the incidence of related complications,and is safe.