无创正压通气在气管切开Ⅱ型呼吸衰竭患者中的疗效观察

Curative effect observation of noninvasive positive pressure ventilation in tracheotomy patients with type Ⅱrespiratory failure

目的:探讨气管切开脱机的COPD并Ⅱ型呼吸衰竭采用有创-无创序贯通气治疗,并拔出气管套管的疗效、安全性。方法:2006年1月-2013年1月收治患者30例,行有创-无创序贯通气治疗,对其临床资料进行回顾性分析。结果:合并左心功不全:11例在无创正压通气支持下,间断试堵管成功,完全堵管观察72~96小时病情稳定后顺利拔出气管套管;2例失败,经行纤维支气管镜和胸部CT检查均发现异常,1例气管造瘘腔环形狭窄,1例气管下端狭窄,放弃拔管。合并OSA:6例拔管成功,3例因咽部组织松弛,卧位睡眠时出现Ⅱ型呼吸衰竭放弃拔管。合并支气管扩张:4例拔管成功,4例因咳嗽频繁,造成人机对抗和不耐受而放弃。所有患者在无创正压通气支持中均未出现皮下或纵隔气肿。结论:采用有创-无创序贯通气治疗,可使部分患者拔出气管套管,节省医疗资源,缩短住院时间,降低医疗费用,减轻痛苦,操作简单,疗效可靠。方法安全。

Objective:To investigate the efficacy and safety of offline COPD and type Ⅱ respiratory failure patients with tracheotomy treated with using invasive to non-invasive sequential ventilation and pulling out the tracheal tube.Methods:30 cases were selected from January 2006 to January 2013.They were treated by invasive to non-invasive sequential ventilation.The clinical data were retrospectively analyzed.Results:Patients were complicated with left ventricular failure:intermittent test tube plugging of 11 cases was successful in noninvasive positive pressure ventilation support.After completely blocking pipe,we observed for 72 to 96 hours,the patient's condition was stable,and then we successfully pulled out the tracheal cannula.2 cases were failure,anomaly was discovered by fiberoptic bronchoscopy and chest CT examination,1 case of tracheal fistula cavity was annular stenosis,and 1 case of lower trachea was narrow.They all gave up extubation.Patients were complicated with OSA:6 cases with extubation were successful,and 3 cases gave up extubation because of pharyngeal tissue relaxation,occuring Ⅱ respiratory failure in supine sleep.Patients were complicated with bronchiectasis:4 cases of extubation were successful,and 4 cases gave up extubation because of frequent cough,man-machine confrontation and intolerance.All cases had no subcutaneous or mediastinal emphysema in noninvasive positive pressure ventilation support.Conclusion:Invasive to non-invasive sequential ventilation treatment can pull out tracheal cannula of most patients.It can save medical resources,shorten the time of hospitalization,reduce the medical cost and ease the pain.The operation is simple,curative effect is reliable,and the method is safe.