有创与无创序贯机械通气治疗COPD重症呼吸衰竭

Effect of sequential non-invasive following short-term invasive mechanical ventilation on COPD patients with severe respiratory failure

目的 评价序贯机械通气治疗COPD重症呼吸衰竭的效果。 方法 选择 2 1例行气管插管机械通气的COPD患者作为序贯治疗组 ,以SIMV +PSV +PEEP方式行机械通气 ,待“肺部感染控制窗”出现 ,拔除气管插管 ,改为经面罩BIPAP无创通气 ,渐至脱机。另选病情相同的 2 1例为对照组 ,行常规有创通气 ,最后以PSV方式至撤机。动态观察两组病例治疗前后各项指标 :以前插管例数 ,呼吸频率 ,血压 ,心率 ,有创通气时间 ,VAP发生例数 ,总机械通气时间 ,住院时间 ,监护时间 ,撤机成功例数 ,院内死亡例数 ,住院费用。 结果 序贯治疗组与对照组 ,有创通气时间分别是 7.4 9± 0 .2 7d和 16 .4 1± 0 .5 3d(P <0 .0 0 1) ,VAP发生例数分别为 0和 16 (χ2 =2 2 .72 ,P <0 .0 0 5 ) ;住院时间分别为 16 .83± 1.88d和 2 6 .4 3± 1.94d(P <0 .0 0 1) ;治疗费用分别为 1.0 1± 0 .2万元 ,1.82± 0 .5万元 (P <0 .0 0 1)。 结论 对COPD严重呼吸衰竭病例 ,待”肺部感染控制窗”出现 ,立即改为BIPAP面罩通气 ,可明显提高治疗效果陈琳 ,女 ,1968年 7月出生 ,大学本科 ,呼吸内科主治医师 ,发表论文

Objective To estimate the effect of sequential non invasive following short term invasive mechanical ventilation (MV) on COPD patients with severe respiratory failure (RF). Methods Forty two COPD patients with severe RF were studied. Among them,21 cases(study group) were treated by sequential non invasive following short term invasive MV when pulmonary infection had been controlled,the others were treated by invasive MV continuously(control group). The sex, age and clinical indications of study group were comparable with control group. Results For study group and control group, the duration of invasive MV was 7.49±0.27 vs 16.41±0.53 days( P<0.001); the incidence of VAP was 0 vs 16/21( P<0.05); the duration of hospitalization was 16.83±1.88 vs 26.43±1.94 days( P<0.001); expenses of hospitalization was 10.1±2.0 vs 18.2±5.0 thousand yuan( P<0.001);respectively. Conclusion In COPD patients requiring intubation and MV, early extubation followed by non invasive MV may significantly increase the efficacy of the comprehensive therapy.