肺部感染控制窗序贯通气在慢性阻塞性肺疾病急性加重期合并呼吸衰竭治疗中的应用价值研究

Application value of pulmonary infection control window sequential ventilation in treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure

目的:探究肺部感染控制(PIC)窗序贯通气在慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭治疗中的应用价值。方法:回顾性分析126例AECOPD合并呼吸衰竭患者的相关资料,依据通气方式将患者分为接受有创正压通气(IPPV)治疗的IPPV组(60例)和接受PIC窗序贯通气治疗的研究组(66例)。比较两组患者治疗前后肺部功能指标和血气指标,以及治疗疗效、治疗相关时间、相关并发症发生情况和预后情况。结果:两组患者治疗后第一秒用力呼气容积占预计值百分比(FEV_(1)%pred)、用力肺活量(FVC)以及FEV_(1)/FVC显著高于治疗前,且研究组患者治疗后FEV_(1)%pred、FVC以及FEV_(1)/FVC高于IPPV组患者(均P<0.05)。与治疗前比较,两组患者治疗后氧分压(PaO_(2))、血氧饱和度(SaO_(2))、pH值上升,二氧化碳分压(PaCO_(2))、呼吸频率(RR)下降(均P<0.05)。研究组患者治疗后PaO_(2)、SaO_(2)、pH值显著高于IPPV组,PaCO_(2)、RR显著低于IPPV组(均P<0.05)。研究组患者治疗总有效率高于IPPV组患者(P<0.05)。研究组患者重症监护室治疗时间、有创通气时间、抗生素用药时间显著低于IPPV组(均P<0.05)。研究组患者呼吸机相关性肺炎发生率低于IPPV组(P<0.05)。两组患者6个月内急性加重、再次入院以及病死率比较差异无统计学意义(均P>0.05)。结论:PIC窗序贯通气治疗有助于缩短AECOPD合并呼吸衰竭患者有创通气治疗时间,纠正机体血气指标紊乱,改善机体肺部通气功能,减少机体呼吸机相关性肺炎发生率,治疗效果显著。

Objective:To investigate the application value of pulmonary infection control(PIC)window sequential ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure.Methods:The study retrospectively analyzed relevant data of 126 patients with AECOPD and respiratory failure.Patients who received intermittent positive pressure ventilation(IPPV)were included in IPPV group(60 cases),while those undergoing PIC window sequential ventilation were included in the study group(66 cases).The lung function indexes,blood gas indexes,therapeutic effects,treatment-related time,occurrence of related complications and prognosis of the two groups were compared.Results:After treatment,the percentage of forced expiratory volume in the first second to the predicted value(FEV_(1)%pred),forced vital capacity(FVC)and FEV_(1)/FVC of the two groups were significantly higher than those before treatment,and those in the study group were higher than those in the IPPV group(all P<0.05).The partial pressure of oxygen(PaO_(2)),blood oxygen saturation(SaO_(2))and pH value increased,and the partial pressure of carbon dioxide(PaCO_(2))and respiratory rate(RR)decreased in the two groups in comparison with those before treatment(all P<0.05).After treatment,the PaO_(2),SaO_(2) and pH values in the study group were significantly higher than those in the IPPV group,and the PaCO_(2) and RR were significantly lower than those in the IPPV group(all P<0.05).The total effective rate of the study group was higher than that in the IPPV group(P<0.05).The treatment time in intensive care unit,invasive ventilation time and antibiotic medication time in the study group were significantly lower than those in the IPPV group(all P<0.05).The incidence of ventilator-associated pneumonia in the study group was lower than that in the IPPV group(P<0.05).There was no significant difference in acute exacerbation,readmission and mortality within 6 months between the two groups(all P>0.05).Conclusion:PIC window sequential ventilation therapy is helpful to shorten the treatment time of invasive ventilation in patients with AECOPD and respiratory failure,correct the disorder of blood gas indexes,improve the pulmonary ventilation function,and reduce the incidence of ventilator-associated pneumonia,which has significant therapeutic effect.