慢性阻塞性肺病呼吸衰竭机械通气患者气管插管拔管时机选择

The decision of extubation during weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease

目的 :研究早拔管和晚拔管对慢性阻塞性肺病 (COPD)呼衰气管插管机械通气患者预后的影响。方法 :选取呼吸监护病房 32例患者 ,随机分为两组 :一组于肺部感染控制后 (表现为痰液量减少 ,体温下降 ,白细胞计数降低 ,X线胸片上支气管 -肺部感染影消退 )即拔管 (早拔管组 ) ,另一组使用经人工气道机械通气进行撤机的传统方法拔管 (晚拔管组 )。两组插管前年龄、病情严重程度、血气分析结果均类似。观察两组的临床经过、预后。结果 :好转出院率早拔管组高于晚拔管组 (70 .6 %vs4 6 .7% ,P <0 .0 1) ,死亡率早拔管组低于晚拔管组 (2 9.4 %vs5 3.3% ,P <0 .0 1) ,气管切开率早拔管组低于晚拔管组 (11.8%vs80 .0 % ,P <0 .0 1)。结论 :早期拔管的方法 ,病人耐受性好 ,撤机成功率高 ,预后好。

Objective: To evaluate the influence on prognosis by two methods of weaning from ventilator in patients with chronic obstructive pulmonary disease (COPD). Methods:Thirty two COPD patients accepted intubation and mechanical ventilation were involved in our study. Their clinical status were similar before intubation. They were divided into two groups: extubation performed once respiratory infection were controlled (early group) and extubation performed followed the strict weaning criteria (late group). The clinical course and prognosis were observed. Results:The tracheostomy rate of early group was lower than that of late group (11.8%vs80.0%,P<0.01); the discharge rate of early group was higher than that of late group (70.6%vs46.7%,P<0.01);and the mortality of early group was lower than that of late group (29.4%vs53.3%,P<0.01). Conclusions: Early extubation (extubation performed when respiratory infection were controlled) may lead better prognosis.