BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmon...BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.展开更多
目的探讨有创-无创序贯机械通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭失败的相关影响因素。方法回顾性分析2016年8月至2018年8月西安市北方医院收治的128例AECOPD合并呼吸衰竭患者的临床资料,所有患者均给予有创-无创序...目的探讨有创-无创序贯机械通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭失败的相关影响因素。方法回顾性分析2016年8月至2018年8月西安市北方医院收治的128例AECOPD合并呼吸衰竭患者的临床资料,所有患者均给予有创-无创序贯机械通气治疗,按治疗效果将其分为有效组93例和无效组35例,比较两组患者的年龄、性别、病程、心率(HR)、血压、低蛋白血症、氧分压(PaO_(2))、二氧化碳分压(PaCO_2)、通气时间、APACHEⅡ评分、并发症情况、C反应蛋白(CRP)水平、血乳酸浓度等一般资料,采用Logistic多因素回归分析法分析治疗失败的相关影响因素。结果两组患者在性别、病程、HR、血压、低蛋白血症、PaO_(2)、通气时间、并发症情况方面比较差异均无统计学意义(P>0.05);无效组和有效组患者在年龄[(68.88±4.43)岁vs (59.02±4.57)岁]、PaCO_2[(83.65±10.12) mmHg vs (73.79±10.54) mm Hg]、APACHEⅡ评分[(19.16±6.68)分vs (11.34±3.85)分]、CRP水平[(89.65±10.31) mg/L vs (80.23±10.21) mg/L]、血乳酸浓度[(2.98±0.60) mmol/L vs (1.93±0.68) mmol/L]方面比较,无效组明显高于有效组,差异均有统计学意义(P<0.05);经Logistic多因素回归分析结果显示,PaCO_2、APACHEⅡ评分、CRP水平、血乳酸浓度是有创-无创序贯机械通气治疗AECOPD合并呼吸衰竭失败的独立影响因素(OR=2.280、2.307、1.042、1.413,P<0.05)。结论 PaCO_2≥75 mmHg、APACHEⅡ评分>15分、CRP≥85 mg/L、血乳酸浓度>1.7 mmol/L是有创-无创序贯机械通气治疗AECOPD合并呼吸衰竭失败的独立危险因素;在制定临床诊疗方案前应考虑上述指标影响,以最大程度地避免治疗失败。展开更多
文摘BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.
文摘目的探讨有创-无创序贯机械通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭失败的相关影响因素。方法回顾性分析2016年8月至2018年8月西安市北方医院收治的128例AECOPD合并呼吸衰竭患者的临床资料,所有患者均给予有创-无创序贯机械通气治疗,按治疗效果将其分为有效组93例和无效组35例,比较两组患者的年龄、性别、病程、心率(HR)、血压、低蛋白血症、氧分压(PaO_(2))、二氧化碳分压(PaCO_2)、通气时间、APACHEⅡ评分、并发症情况、C反应蛋白(CRP)水平、血乳酸浓度等一般资料,采用Logistic多因素回归分析法分析治疗失败的相关影响因素。结果两组患者在性别、病程、HR、血压、低蛋白血症、PaO_(2)、通气时间、并发症情况方面比较差异均无统计学意义(P>0.05);无效组和有效组患者在年龄[(68.88±4.43)岁vs (59.02±4.57)岁]、PaCO_2[(83.65±10.12) mmHg vs (73.79±10.54) mm Hg]、APACHEⅡ评分[(19.16±6.68)分vs (11.34±3.85)分]、CRP水平[(89.65±10.31) mg/L vs (80.23±10.21) mg/L]、血乳酸浓度[(2.98±0.60) mmol/L vs (1.93±0.68) mmol/L]方面比较,无效组明显高于有效组,差异均有统计学意义(P<0.05);经Logistic多因素回归分析结果显示,PaCO_2、APACHEⅡ评分、CRP水平、血乳酸浓度是有创-无创序贯机械通气治疗AECOPD合并呼吸衰竭失败的独立影响因素(OR=2.280、2.307、1.042、1.413,P<0.05)。结论 PaCO_2≥75 mmHg、APACHEⅡ评分>15分、CRP≥85 mg/L、血乳酸浓度>1.7 mmol/L是有创-无创序贯机械通气治疗AECOPD合并呼吸衰竭失败的独立危险因素;在制定临床诊疗方案前应考虑上述指标影响,以最大程度地避免治疗失败。
