AECOPD呼吸衰竭序贯机械通气治疗转换时机研究

目的探讨慢性阻塞性肺疾病（COPD）急性呼吸衰竭从有创过渡到无创机械通气的适宜时机。方法将28例AECOPD急性呼吸衰竭患者有创机械通气3～5d后随机分成两组。A组予拔除气管导管改面罩机械通气，B组继续有创机械通气。观察两组呼吸机相关性肺炎（VAP）例数、死亡例数、机械通气时间、住院时间。结果A、B两组发生VAP的例数分别为0例和5例（P=0．027）；死亡例数为O和3例（P=0．217）；有创机械通气3～5d后尚需机械通气时间为（7．8±3．4）d和（15．6±9．3）d，P〈0．05；住院时间为（15．8±4．7）d和（23．6±10．8）d，P〈0．05。结论以肺部感染控制窗（PIC）作为有创通气与无创通气切换点救治AECOPD急性呼吸衰竭有创机械通气3～5d后拔除气管导管改面罩机械通气，能降低VAP发生率，缩短机械通气时间和住院天数，减少病死率。

Value of the Right Time to the Shift of Invasive and Noninvasive Ventilation-Clinical Characteristics to the Treatment of AECOPD with Respiratory Failure

Objective To discuss the optimal time for extubation and sequential non-invasive mechanical ventilation in AECOPD patients with exacerbated respiratory failure who received invasive ventilation. Methods 28 patients received invasive ventilation for 3-5 days were randomly assigned to receive noninvasive ventilations （ study group） or to continue the weaning process with invasive ventilation （ control group）. The incidence of ventilator-associated pneumonia （ VAP）, the incidence of death, the du- ration of ventilation, and the hospitalization were analyzed in two groups. Results Between study group and control group, the in- cidence of VAP was 0 vs 5 ,P =0. 027 ;the incidence of death was 0 vs 3 ,P =0. 217 ;the continued duration of ventilation after invasive ventilation for 3-Sdays was （7.8 ±3.4） days vs （ 15.6 ±9.3） days,P 〈0.05 ;the hospitalization was （ 15.8 ±4.7） days vs （ 23.6 ± 10.8 ） days, P 〈 0.05. Conclusion In AECOPD patients with exacerbated respiratory failure who received invasive ventilation,invasive ventilation for 3-5 days followed by noninvasive ventilation may decrease the incidence of VAP, shorten the duration of ventilation and hospitalization.