有创-无创序贯机械通气治疗在COPD并呼吸衰竭中的应用

目的：评价有创-无创序贯机械通气治疗慢性阻塞性肺疾病急性加重期（AECOPD）并呼吸衰竭的疗效.方法：对36例COPD并呼吸衰竭患者进行气管插管机械通气治疗,达到肺部感染控制窗（PIC窗）后,随机分为序贯通气治疗组20例和常规通气组16例,序贯通气组治疗方法：立即拔出气管插管,改口鼻面罩双水平气道正压通气（BiPd）治疗;常规通气组治疗方法：继续按常规有创机械通气方法治疗,随后以临床常用压力支持通气（PSV）模式脱机,两组同时进行监护,观察两组患者有创通气时间、总机械通气时间、呼吸机相关肺炎（VAP）例数、病死率、住院时间、住院费等.结果：两组患者发生VAP的例数分别为2例（10％）和6例（37.5％）（P＜0.05）,有创机械通气时间分别为（4.3±2.3）d和（11.8±5.3）d（P＜0.05）,住院时间分别为（22 ＋9）d和（25±14）d.结论：在PIC窗指导下的有创与无创序贯性通气治疗方法,可明显缩短有创通气时间,降低VAP发生率,缩短住院时间,降低治疗费用,提高抢救成功率.

Application of invasive-noninvasive sequential ventilation in the treatment of respiratory failure patients with COPD

Objective：To evaluate the value of invasivenoninvasive sequential ventilation in the treatment of severe respiratory failure patients with COPD.Methods：36 patients with COPD and respiratory failure,who underwent endotracheal intubation mechanical ventilation treatment,and achieved the pulmonary infection control window（PIC window）,were randomly divided into two groups：20 cases of sequential ventilation and 16 cases of conventional ventilation.For sequential ventilation group therapy：immediate extubation,changed to non—invasive mechanical ventilation（BiPAP）; conventional ventilation group was kept treating by invasive mechanical ventilation and weaned by PSV mode.The duration of invasive mechanical ventilation,total mechanical ventilation,hospitalization and care,the incidence of ventilator—associated pneumonia（VAP）,fatality rate,hospitalization time were compared between two groups.Results：The incidences of VAP of patients in two groups were 2 cases（10%） and 6 cases（37.5%） respectively（P〈0.05）.Invasive mechanical ventilation time were（4.3 ± 2.3） d and（11.8 ± 5.3） d（P〈0.05）.Duration of hospitalization were（22 ± 9） d and（25 ± 14） d.Conclusion：Under the guidance of PIC window,the treatment of sequential invasive and non-invasive ventilation can significantly shorten invasive mechanical ventilation time,reduce the incidence of VAP,shorten the hospitalization time,reduce the cost of treatment,and improve the rate of rescue.