序贯机械通气在慢性阻塞性肺疾病并呼吸衰竭中的应用

目的：探讨序贯机械通气在慢性阻塞性肺疾病（COPD）合并呼吸衰竭中的应用价值。方法：收集2011年4月至2013年2月广东省揭阳市人民医院收治的40例COPD合并呼吸衰竭的患者作为研究对象，随机分为序贯组（序贯机械通气）和传统组（有创机械通气），每组20例。比较两组生命体征、血气分析、呼吸机参数、呼吸机相关性肺炎发生率、死亡率、有创机械通气时间、住ICU时间、住院费用等指标，、结果：两组患者生命体征、血气分析、呼吸机参数比较，差异无统计学意义（P〉0．05），序贯组有创机械通气时间、ICU入住时间、住院费用、呼吸机相关性肺炎发生率、死亡率均少于传统组（P〈0．05），结论：对于COPD合并严重呼吸衰竭，序贯机械通气可降低呼吸机相关性肺炎发生率和死亡率下降，缩短有创机械通气时间、ICU入住时间，减少住院费用，是较好的机械通气策略。

Sequential mechanical ventilation in chronic obstructive pulmonary disease with concomitant respiratory failure

Objective：To investigate the value of sequential mechanical ventilation in patients with chronic obstructive pulmonary disease （COPD） and concomitant respiratory failure. Methods： A total of 40 patients with COPD and concomitant respiratory failure admitted to Guangdong Jieyang People＇ s Hospital between April 2011 and February 2013 were randomly assigned to receive sequential mechanical ventilation （sequential ventilation group, n = 20） or invasive mechanical ventilation （conventional ventilation group, n = 20）. The vital signs, blood-gas analysis indices, parameters of respirator, incidence of respirator-associated pneumonia, mortality, duration of invasive mechanical ventilation, length of ICU stay and cost of hospital stay were compared. Results： The difference in vital signs, blood-gas analysis indices and parameters of respirator was unremarkable （ all P 〉 0.05）. Sequential ventilation group was associated with reduced incidence of respirator-associated pneumonia, mortality, duration of invasive mechanical ventilation, length of ICU stay and cost of hospital stay （all P 〈 0. 05 ）. Conclusion ： Sequential mechanical ventilation is a preferable strategy for mechanical ventilation owing to a lower incidence of respirator-associated pneumonia and mortality as well as reduced duration of invasive mechanical ventilation, length of ICU stay and cost of hospital stay in patients with COPD and concomitant respiratory failure.