改良肺部感染控制窗指导有创-无创序贯通气治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭的效果分析

Clinical effects of modified pulmonary infection control window guided invasive-noninvasive sequential ventilation in the treatment of acute exacerbation chronic pulmonary disease with respiratory failure

目的探讨改良肺部感染控制窗指导有创-无创序贯通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭的临床效果。方法抽取2015年1月至2018年6月于徐州市第一人民医院治疗的AECOPD合并呼吸衰竭患者50例,按随机数字表法分为观察组和对照组。对照组给予气管插管和机械辅助通气治疗,观察组给予改良肺部感染控制窗指导有创-无创序贯通气治疗。比较两组治疗效果。结果观察组的总住院时间、总机械通气时间、有创机械通气时间、重症监护室住院时间均短于对照组,呼吸频率、心率、呼吸机相关肺炎(VAP)均少于对照组,差异有统计学意义(P<0.05);两组患者治疗后动脉血氧分压、pH、呼气末二氧化碳分压水平均升高,动脉二氧化碳分压均下降,且观察组改善更显著,差异有统计学意义(P<0.05)。治疗后,两组第1秒用力呼出量、呼出25%肺容积时的最大呼气流量、呼出50%肺容积时的最大呼气流量均显著升高,且观察组升高更显著,差异有统计学意义(P<0.05)。结论改良肺部感染控制窗指导有创-无创序贯通气治疗AECOPD合并呼吸衰竭的效果较好,可改善患者的肺通气、血气指标,改善机体的炎症反应,有效改善预后,在临床上有积极的意义。

Objective To investigate the clinical effects of modified pulmonary infection control window guided invasive-noninvasive sequential ventilation in the treatment of acute exacerbation chronic pulmonary disease(AECOPD)with respiratory failure.Methods Fifty AECOPD patients with respiratory failure treated in Xuzhou First People’s Hospital from January 2015 to June 2018 were selected and divided into observation group and control group by random number table method.The control group was given tracheal intubation and mechanical ventilation,while the observation group was given invasive-noninvasive sequential ventilation under the guidance of improved pulmonary infection control window.The therapeutic effects of the two groups were compared.Results The total hospitalization time,total mechanical ventilation time,invasive mechanical ventilation time and intensive care unit stay time in the observation group were shorter than those in the control group(P<0.05).And the respiratory rate,heart rate and ventilation-associated pneumonia incidence were less than those in the control group(P<0.05).After treatment,the levels of partial pressure of oxygen in arterial blood,pH and end-tidal carbon dioxide tension in both groups increased(P<0.05);while partial pressure of carbon dioxide in arterial blood decreased,and the changes in the observation group were more significant(P<0.05).Forced expiratory volume in 1 second,forced expiratory flow at 25%to 50%increased significantly after treatment,and the increases in the observation group were more significant(P<0.05).Conclusions Modified pulmonary infection control window guided invasive-noninvasive sequential ventilation is effective in the treatment of AECOPD with respiratory failure.It can improve pulmonary ventilation and blood gas index,alleviate inflammatory response,and effectively improve prognosis.