【摘要】 目的探讨以呼吸泵衰竭改善窗为切换时机序贯通气治疗慢性阻塞性肺疾病(COPD)并呼吸衰竭的应用价值。方法以COPD并呼吸衰竭经有创机械通气治疗好转,呼吸泵衰竭改善窗出现后的106例患者为研究对象。随机分为有创-无创序贯通气治疗组(序贯通气组)52例和传统治疗组(对照组)54例。序贯通气组立即拔除气管插管,应用无创正压通气支持脱机;对照组以传统有创机械通气方式脱机。比较两组有创机械通气时间、住ICU时间、呼吸机相关性肺炎(VAP)发生率、再插管率和住院死亡率。结果两组有创机械通气时间分别为(3.9±1.5)d和(15.5±6.1)d,住ICU的时间分别为(4.9±1.8)d和(20.3±5.5)d,VAP发生率分别为15.38%(8/52)和35.19%(19/54),病死率分别为11.54%(6/52)和27.78%(15/54),两组比较差异均有统计学意义(P均<0.05)。两组再插管率分别为19.23%(10/52)和16.67%(9/54),差异无统计学意义(P均>0.05)。结论对COPD并呼吸衰竭需有创机械通气患者,当呼吸泵衰竭改善窗出现后,立即拔管改无创序贯通气治疗,可以缩短有创通机械通气时间及住ICU的时间,降低VAP发生率及住院死亡率。更多还原

【Abstract】 Objective To evaluate the application of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease( COPD) patients with severe respiratory failure by investigating the appearance of respiratory pump failure improved window( RPFIW). Methods COPD patients with severe respiratory failure receiving invasive mechanical ventilation( MV) were involved in the study. When the RPFIW appeared by the antibiotic and comprehensive therapy,106 cases were randomized into invasive-noninvasive sequential mechanical ventilation group and control group. The early extubation was conducted and followed by noninvasive mechanical ventilation via facial mask immediately in the sequential mechanical ventilation group. Conventional invasive mechanical ventilation was used as the weaning technique in the control group. The incidence of ventilator-associated pneumonia( VAP),incidence of reintubation and mortality,the duration of invasive mechanical ventilation and days in ICU were analyzed and compared. Results There were 52 cases in the sequential mechanical ventilation group,54 cases in the control group. In the sequential mechanical ventilation group,the duration of invasive mechanical ventilation was( 3. 9 ±1. 5) d,while the duration was( 15. 5 ± 6. 1) d in the control group( P < 0. 05). The durations of ICU stay was( 4. 9 ±1. 8) d in the sequential mechanical ventilation group,( 20. 3 ± 5. 5) d in the control group( P < 0. 05). The incidence of VAP was 15. 38%( 8 /52) in the sequential mechanical ventilation group,35. 19%( 19 /54) in the control group respectively( P < 0. 05). Hospital mortality was 11. 54%( 6 /52) in the sequential mechanical ventilation group,and 27. 78%( 15 /54) in the control group( P < 0. 05). The incidence of reintubation was 19. 23%( 10 /52)in the sequential mechanical ventilation group,16. 67%( 9 /54) in the control group( P > 0. 05). Conclusion In those COPD patients requiring invasive mechanical ventilation with severe respiratory failure due to respiratory pump failure,sequential noninvasive following invasive mechanical ventilation at the appearance of respiratory pump failure improved window might significantly reduce duration of invasive mechanical ventilation,and days in ICU stay,and decrease the occurrence of VAP and hospital mortality.更多还原