有创与无创序贯机械通气治疗重症慢性阻塞性肺疾病

对24例慢性阻塞性肺疾病重症呼吸衰竭患者进行有创机械通气治疗，随机分为序贯治疗组和对照组（各12例）。达到肺部感染控制窗后，序贯组立即拔出气管插管，改用口鼻面罩行双水平气道正压无创通气（BiPAP）治疗至脱机；对照组继续行常规有创机械通气，以目前临床常用压力支持通气（PSV）模式脱机。观察两组患者机械通气总时间、有创通气时间、监护时间、住院时间、呼吸机相关肺炎发生情况等。序贯治疗组较对照组机械通气总时间[（7．8±2．5）d与（12．0±2．2）d]、有创通气时间[（4．9±2．2）d与（12．0±2．2）d]、住院时间[（8．5±2．5）d与（13．0±2．6）d]明显缩短（P〈0．05），呼吸机相关肺炎的发生率亦低于对照组（0／12与3／12）。说明在肺部感染控制窗指导下序贯性通气治疗方法可以明显缩短机械通气时间、重症监护和总住院时间，降低呼吸机相关肺炎发生率，改善患者预后。

Application of invasive and non-invasive sequential ventilation in severe chronic obstructive pulmonary disease

Twenty four patients of chronic obstructive pulmonary disease complicated with severe respiratory failure were divided into two groups randomly: sequential ventilation group and control ventilation group (n = 12 in each group). Patients in sequential group received invasive ventilation at beginning, once the pulmonary infection control window (PICW) reached the trachea cannula was extubated immediately replaced by Bi-level positive airway pressure( BiPAP) noninvasive ventilation with oral-nasal mask; while in control ventilation group the invasive ventilation was continued using pressure support ventilation (PSV) until stopping mechanical ventilation. The total ventilation time, the invasive ventilated time,the length of stay in hospital,monitoring time and the incidence rate of ventilation associated pneumonia (VAP) were evaluated in two groups. The total ventilation time [(7. 8 ±2. 5 ) d, (12 ±2. 2) d], the invasive ventilated time [(4. 9 ±2. 2)d, and (12 ± 2. 2) d] the length of hospital stay [(8. 5 ± 2. 5 ) d, (13 ± 2. 6) d] in the sequential ventilation group were significantly shorter than those in the control ventilation group (P ＜ 0.05); the incidence rate of VAP was lower than that in the control group. The results indicates that sequential ventilation with the guidance of PICW can shorten the total ventilation time, the critical monitoring time and the length of hospital stay, it can also reduce the incidence of VAP and improve the prognosis of patients.