有创-无创机械通气序贯治疗严重呼吸衰竭的临床研究

目的：探讨有创-无创机械通气序贯脱机治疗严重呼吸衰竭的临床疗效。方法：35例严重呼吸衰竭患者采用以呼吸泵衰竭改善为切换点的有创-无创机械通气序贯脱机治疗，设为序贯治疗组，35例严重呼吸衰竭患者采用常规有创机械通气脱机治疗，设为对照组。动态观察并比较两组患者总机械通气时间、有创机械通气时间、重新插管率、呼吸机相关肺炎（ VAP ）发生率、住院时间。结果：有创-无创机械通气序贯脱机治疗重度呼吸衰竭疗效显著。两组机械通气前APACHEⅡ评分比较差异无显著性（ P＞0．05）。序贯组总机械通气时间、有创机械通气时间、住院时间及呼吸机相关性肺炎发生率较对照组明显降低，差异有显著性（ P＜0．05）。结论：以呼吸泵衰竭改善为切换点的有创-无创机械通气序贯治疗可显著降低患者总机械通气时间、有创机械通气和住院时间，减少呼吸机相关性肺炎的发生。

The Effect of Sequential Invasive to Noninvasive Mechanical Ventilation in Severe Respiratory Failure

Objective：To explore the clinical therapeutic effect and feasibility of sequential invasive to noninvasive mechanical ventilation in severe respiratory failure .Method： Treatment group was 35 patients with severe respiratory failure underwent sequential invasive and noninvasive mechanical ventilation at the switch-point of respiratory pump failure improved ,control group was 35 patients with underwent conventional treatment ,and analysed and compared the total mechanical ventilation time , pressure invasive mechanical ventilation time , incidence rate of repeated tracheal intubation , the incidence rate of ventilator associated pneumonia （ VAP ） and total length of stay .Result： Sequential invasive and noninvasive mechanical ventila-tion in severe respiratory failure had significant therapeutic effect .There was no significant difference of A-PACHEⅡscore between the two groups .The total mechanical ventilation time , pressure invasive mechanical ventilation time , total length of stay and the incidence rate of VAP in treatment group were lower than con-trol group（P〈0.05）.Conclusion：Sequential invasive and noninvasive mechanical ventilation at the switch-point of respiratory pump failure improved can reduce total mechanical ventilation time , the pressure invasive mechanical ventilation time and total length of stay .It can reduce the incidence rate of VAP .