危重肺心病救治时无创和有创通气相互转换时血气监测意义

目的探讨危重慢性阻塞性肺疾病(COPD)救治时无创和有创正压通气相互转换时血气监测的意义.方法 入住ICU病房的危重COPD患者首先应用无创正压通气(NPPV),然后根据血气分析结果及病情情况,及时转换为有创正压通气(IPPV)为A组,维持NPPV治疗为B组.比较两组的病死率、呼吸机相关性肺炎(VAP)发生率、机械通气时间及住ICU时间.结果 A组病死率为13.3%,B组病死率为100%,A组病死率明显低于B组(P＜0.05);A组VAP发生率较B组明显降低(P＜0.05);A组机械通气时间和住ICU时间较B组明显缩短(P＜0.05).结论对危重肺心病患者机械通气治疗期间,根据血气分析的结果及病情准确把握从无创到有创或有创到无创的转换时机,灵活选用NPPV和IPPV,可提高治疗效果,降低VAP发生率和病死率.

Meaning of monitoring blood gas in mutual switch between invasive ventilation and noninvasive ventilation in the treatment of patients with critical chronic obstructive pulmonary disease

Objective To estimate the meaning of monitoring blood gas in mutual switch between invasive ventilation and noninvasive positive pressure ventilation in the treatment of patients with critical chronic obstructive pulmonary disease.Methods Patients with critical COPD admitted to ICU were treated with noninvasive positive pressure ventilation at first, and then were divided into two groups according to the results of blood gas analysis and relative conditions. Group A were treated with immediate switch to NIPPV. Group B were treated with no switch. Mortality, the incidence of ventilation associated pneumonia, the duration of mechanical ventilation and ICU stay were compared between the two groups.Results The mortality (13.3%) in patients of group A was significantly lower than that (100%) in patients of group B (P<0.05). Incidence of VAP in patients of group A was significantly lower than that of group B (P<0.05). The duration of mechanical ventilation and ICU stay in patients of group A were obviously shorter than those of group B (P<0.05). Conclusion During mechanical ventilation of critical COPD patients, it is very important to determine the optimum time to switch mechanical ventilation from NIPPV to invasive ventilation or from invasive ventilation to NIPPV according to the results of blood gas analysis and relative conditions. A prompt change of mechanical ventilation mode can improve outcome of the patients and decrease the incidence of VAP and mortality.