无创序贯通气治疗在慢性阻塞性肺疾病合并肺性脑病中的临床应用

Clinical application of noninvasive sequential ventilation in patients with chronic obstructive pulmonary disease complicated with pulmonary encephalopathy

目的探讨有创-无创序贯通气治疗在慢性阻塞性肺疾病合并肺性脑病患者中的临床应用价值。方法选取新疆某三甲医院2018年1月至2018年12月重症医学科收治的50例慢性阻塞性肺疾病合并肺性脑病患者作为研究对象,按照随机分组的原则分为序贯治疗组和对照组,各25例。两组均给予相同的抗菌素抗感染、化痰、解痉止喘等常规治疗,序贯治疗组在肺部感染控制窗(PIC窗)出现后拔气管插管,改为无创辅助通气,对照组继续实施PSV+SIMV模式机械通气,拔管后给予低流量鼻导管吸氧。比较两组患者在肺部感染控制窗(PIC窗)时及撤机24 h后血气分析变化,同时比较住ICU时间、再插管率、死亡率、呼吸机相关性肺炎(VAP)发生率。结果无创序贯通气治疗组住ICU时间、再插管率、死亡率、呼吸机相关性肺炎(VAP)发生率均低于对照组,差异有统计学意义(P <0.05)。两组血气分析指标在肺部感染控制窗(PIC窗)时与拔管24h后比较,差异无统计学意义(P> 0.05)。结论无创序贯通气治疗在慢性阻塞性肺疾病合并肺性脑病中可明显缩短ICU住院时间,降低再插管率、死亡率及呼吸机相关性肺炎(VAP)发生率,同时能够减轻住院经济负担,值得临床推广应用。

Objective To evaluate the clinical value of invasive and noninvasive sequential ventilation in patients with chronic obstructive pulmonary disease complicated with pulmonary encephalopathy. Methods 50 patients with chronic obstructive pulmonary disease complicated with pulmonary encephalopathy were randomly divided into the sequential treatment group(n = 25)and the control group(n = 25) from January 2018 to December 2018. Both groups were given the same antibiotic anti-infection, expectoration,antispasmodic and asthma treatment. In the sequential treatment group, tracheal intubation was performed after the pulmonary infection control window(PIC window)appeared and changed to noninvasive auxiliary ventilation, while the control group continued. PSV+SIMV mode mechanical ventilation was performed, and low flow nasal catheter was given oxygen inhalation after extubation. The changes of blood gas analysis, ICU time, re-catheterization rate, mortality and(VAP)incidence of ventilator-associated pneumonia were compared between the two groups at the time of pulmonary infection control window(PIC window)and 24 hours after withdrawal. Results The ICU time,re-catheterization rate, mortality and(VAP)incidence of ventilator-associated pneumonia in the noninvasive sequential ventilation group were significantly lower than that of the control group(P < 0.05). Two groups of blood gas analysis indexes at the pulmonary infection control window(PIC window) and extubation for 24 hours There was no significant difference between the two groups(P > 0.05).Conclusion Noninvasive sequential ventilation can significantly shorten the hospitalization time of ICU, reduce the rate of re-catheterization, mortality and the incidence of(VAP) in patients with chronic obstructive pulmonary disease complicated with pulmonary encephalopathy. At the same time, it can reduce the economic burden of hospitalization, which is worthy of clinical application.