有创序贯无创机械通气配合中医药治疗慢性阻塞性肺疾病急性呼吸衰竭临床观察

目的:观察有创序贯无创机械通气配合中医药治疗慢性阻塞性肺疾病(COPD)急性加重期呼吸衰竭的临床疗效。方法:将符合诊断标准的COPD急性加重期呼吸衰竭患者随机分为2组,治疗组16例,对照组9例。2组均采用有创序贯无创机械通气的方法,以肺部感染控制窗作为切换点,治疗组加用中医辨证分期治疗。比较两组的通气及氧合指标、肺部感染控制窗出现时间、接受有创通气时间、总机械通气时间、ICU住院时间、发生呼吸机相关性肺炎(VAP)的例数、重新气管插管例数、撤机成功例数及死亡例数。结果:治疗组患者在拔管3h后维持良好通气指标,与治疗前无显著性差异(P>0·05)。治疗组出现肺部感染控制窗的时间较对照组缩短,P=0·0302;出窗时通气、心率指标均较机械通气前好转,两组间各指标差异无显著性(P>0·05)。治疗组有创机械通气时间和总的机械通气时间、ICU时间较对照组显著缩短(P<0·05),脱机成功率显著增高(P<0·05),VAP的发生率显著降低(P<0·01),两组死亡率及重新气管插管率差异无显著性(P>0·05)。结论:中医治疗可提高有创序贯无创机械通气治疗的通气效率,较快控制肺部感染,缩短机械通气时间及ICU住院时间,提高撤机率。

Clinical Effects of Sequential Invasive Following Noninvasive MV Combination with TCM in Patients with Acute Respiratory Failure Induced by COPD

Objective:To evaluate the clinical effects of sequential invasive following non-invasive mechanical ventilation (MV) combination with Traditional Chinese Medicine (TCM) in patients with acute respiratory failure induced by chronic obstructive pulmonary disease (COPD). Methods:Patients were randomized into two groups, TCM group and control group. Sixteen patients involved in the study were in TCM group, and another nine were in control group. INV was used in patients in two groups. Pulmonary infection control window (PIC window) was throwback key. To compare two groups in ventilation, oxygenate index, the time of PIC window, the time of invasive mechanical ventilation, the time of mechanical ventilation, the duration of ICU stay, the incidence of ventilation associated pneumonia (VAP), re-intubation rate, the success ratio of weaning of mechanical ventilation and the mortality in hospital. Results:TCM group after weaning of ventilator was better ventilating after 3 hours, showed no difference before therapy (P>0.05). The time of occurrence of PIC window in TCM group was shorter than that of control group(P=0.0302). There was an improvement of ventilation, heart rate (HR) at the time of PIC window, but no significant difference from control group(P>0.05). In TCM group, the duration of invasive MV and total MV, the duration of ICU stay was shorter than that in control group(P<0.05), success ratio of weaning of MV was higher than the other(P<0.05). The incidence of VAP was reduced than that in control group(P<0.01), the mortality in hospital and re-intubation rate showed no difference in the two groups(P>0.05). conclusions:The TCM treatment could enhance ventilation efficiency of sequential invasive following non-invasive mechanical ventilation, comparatively quickly control the pulmonary in fection, reduce the time of mechanical ventilation and the duration of ICU stay, increase the success ratio of weaning of mechanical ventilation.