纤维支气管镜联合有创加无创机械通气序贯治疗老年COPD严重呼吸衰竭的临床研究

Clinical study of treatment of elder COPD induced hypercapnic respiratory failure by bronchoscopy combined with sequential non-invasive following short-term invasive mechanical ventilation

目的 观察老年慢性阻塞性肺疾病 (COPD)严重呼吸衰竭采用纤支镜联合有创加无创序贯机械通气治疗的效果。方法 对内科保守治疗无效的老年COPD严重呼吸衰竭患者 ,随机分为纤支镜联合有创加无创序贯机械通气治疗的纤支镜组 (A组 )和有创加无创序贯机械通气治疗的对照组 (B组 ) ,比较二组病例呼吸衰竭纠正时间、出现肺部感染控制窗的时间、有创和总机械通气时间、机械通气后住院天数、病死率及呼吸机相关性肺炎 (VAP)的发生情况。结果 A、B二组除病死率 (10 .5 3% )和 (16 .6 7% )相仿 (P >0 .0 5 )外 ;呼吸衰竭纠正时间分别为 (9.2 7± 4 .6 7)和 (2 6 .6 1± 12 .35 )h(P <0 .0 1) ;出现感染控制窗的时间分别为 (4.93± 1.77)和 (9.1± 2 .3)d(P <0 .0 1) ;有创机械通气时间分别为 (5 .2± 2 .1)和 (9.2± 3.1)d(P <0 .0 1) ;总机械通气时间分别为 (11.4 8± 2 .37)和 (15 .13± 2 .5 9)d(P <0 .0 1) ;呼吸机相关肺炎发生例数分别为 0和 3例 ,(P <0 .0 5 ) ;机械通气后住院时间分别为 (18.11± 3.2 4 )和 (2 4 .5 6± 4 .6 2 )d(P <0 .0 1) ;两组间比较差异有显著性 (P<0 .0 1)。结论 纤支镜联合有创加无创序贯机械通气是治疗COPD严重呼吸衰竭患者有效的手段 ,由于能迅速控制感染。

Objective:To observe the efficacy of bronchoscope combined with sequential non-invasive following short-term invasive mechanical ventilation in COPD with hypercapnic respiratory failure.Methods:The cases were distributed into the study group and the control group at random.The patients were treated with bronchoscope combined with sequential non-invasive following short-term invasive mechanical ventilation as study group,the others control group. Compare the time of correting respiratory failure,initial time of PIC window (Pulmonary Infection Control window),the duration of invasive MV,the total duration of ventilatory support,the duration of hospitalization after ventilation,mortality rate and the incidence of VAP .Results:For study groups and control group,the groups had similar clinical mortality rate,10.53% vs 16.67%,P >0.05.The time of correcting respiratory failure was (9.27±4.67) vs (26.61±12.35) hours,( P <0.01).The initial time of PIC window (4.93±1.77) vs (9.1±2.3) days,( P <0.01).The duration of invasive MV was (5.2±2.1) vs(9.2±3.1) days,( P <0.01).The total duration of ventilatory support was (11.48±2.37)vs (15.13±2.59)days,( P <0.01).The incidence of VAP were 0 vs 3,( P <0.05).The duration of hospitalization after ventilaton was (18.11±3.24)vs (24.56±4.62)days,( P <0.01).Conclusions:The therapy of bronchoscope combined with sequenqtial non-invasivc following short-term invasive mechanical ventilation is effective in COPD with hypercapnic respiratory failure .It can control infection,decrease the durations of MV and hospitalization,reduce the incidence of the complication.For example,VAP and the difficulty of taking off mechanical ventilation.