不同时间气管拔管对慢性阻塞性肺疾病患者机械通气后的影响

目的:探讨不同时间拔管对COPD患者后续治疗结果及预后的影响。方法:选择2009年6月～2012年2月收治的19例COPD急性加重期机械通气患者,根据拔管时间不同分为即刻拔管组(IE组,10例)和延迟拔管组(DE组,9例)。程序化撤机评估后脱机,并拔除气管插管,记录脱机、拔管后相关数据。结果:入选患者在性别、年龄、疾病严重程度等方面差异比较无统计学意义。10例IE组病人中1例咳嗽评分增加,2例痰液量、2例呼吸次数、1例心率增加。9例DT组病人中6例咳嗽评分增加,7例痰液量、7例呼吸次数、6例心率增加,差异比较有统计学意义(P<0.05);10例IE组病人外周血中性粒细胞计数(8.02±0.95)×109/L、CRP(8.30±2.26)μg/ml、心率(73.7±3.8)次/分,与DE组外周血中性粒细胞计数(11.55±1.12)×109/L、CRP(43.00±14.24)μg/ml、心率(113.8±12.5)次/分比较,差异具有统计学意义(P<0.05)。结论:COPD患者并呼吸衰竭行机械通气脱机后,不同时间拔管与后续临床表现联系密切。即刻拔管可以减少并发症,有利于病情恢复。

Effects of tracheal extubation at diverse phase on COPD patients undergoing me-chanical ventilation

Objective:To observe the effects and outcomes of extubation at different phase in patients with chronic obstructive pulmonary disease(COPD)undergoing mechanical ventilation.Methods:Between Jun.2009 and Feb.2012,19 COPD patients in their acute exacerbation stage managed with mechanical ventilation were allocated to group of either instant tracheal extubation(IE,n=10) or delayed tracheal extubation(DE,n=9)on basis of diverse weaning time.Weaning from ventilator and subsequent extubation were carried out after programmed assessment.The parameters were kept concerning ventilator withdrawal and post-extubation.Results:No statistical difference was seen regarding the sexes,ages and degree of the disease in the total 19 patients.Of the 10 patients in IE group,scoring for the sputum was increased 1,sputum volume in 2,respiratory frequency in 2 and heart rate in 1.In DE group,increased scoring for the sputum was seen in 6,and elevated sputum volume,respiration rate and heart rate occurred in 7,7 and 6,respectively.The two groups were statistically different(P<0.05).Also,the peripheral blood neutrophil count(8.02±0.95),C-reactive protein(CRP,8.30±2.26) and heart rate(73.7±3.8) in IE group were statistically different DE group(11.55±1.12,43.00±14.24,113.8±12.5,respectively.)(P<0.05).Conclusion:Tracheal extubation at different phase for COPD patients complicated with respiratory failure after weaning from the ventilator can be associated with therapeutic outcomes and prognosis.Instant extubation appears to reduce the complications and favorable to early recovery.