有创机械通气治疗COPD合并呼吸衰竭三种不同撤机方式的临床疗效比较

目的比较慢性阻塞性肺疾病（COPD）合并呼吸衰竭行机械通气患者应用三种不同撤机方式GCS评分、感染控制窗、自主呼吸试验（SBT）]治疗的临床疗效。方法将120例COPD合并呼吸衰竭患者按撤机方式随机分为GCS评分组、感染控制窗组、SBT组,每组各40例。3组均采用同步间歇强制通气＋压力支持方式（SIMV＋PSV）行机械通气。GCS评分组待GCS评分达15分,稳定2 h至窗口期出现;感染控制窗组待肺部感染明显控制时判为＂肺部感染控制窗＂出现;SBT组待SBT成功后,拔除气管导管改无创通气直至脱离呼吸机。动态观察3组患者机械通气前通气及氧合指标、接受有创机械通气时间、总机械通气时间、总住院时间、重新插管率及呼吸机相关性肺炎（VAP）发生率。结果 GCS评分组有创通气时间、总机械通气时间、总住院时间均短于其他两组（P均〈0.05）,感染控制窗组有创通气时间、总机械通气时间、总住院时间均短于SBT组（P均〈0.05）;GCS评分组、感染控制窗组的VAP发生率均低于SBT组（P均〈0.05）,但GCS评分组、感染控制窗组的VAP发生率差异无统计学意义（P〉0.05）。3组重新插管率、病死率比较差异无统计学意义（P均〉0.05）。结论 COPD合并呼吸衰竭行机械通气患者应用GCS评分撤机方式治疗可缩短有创机械通气时间、总机械通气时间、住院时间,并可减少VAP发生率,改善患者的治疗效果。

The efficacy comparison of three weaning modes in the treatment of COPD with respiratory failure using invasive mechanical ventilation

Objective To compare the clinical therapeutic effect of three weaning modes Glasgow coma scale （ GCS）, pulmonary infection control window, spontaneous breathing trial （SBT） ] in the treatment of chronic obstructive pulmonary disease （COPD） with respiratory failure using invasive mechanical ventilation. Methods A total of 120 COPD patients with respiratory failure were randomly divided into 3 groups according to weaning mode （ n = 40 each） ： GCS group, pulmonary infection control window （PIC） group and SBT group. Invasive mechanical ventilation with synchronous intermittent mandatory ventilation （SIMV） plus pressure support ventilation （PSV） mode was given to all the patients. Extubating endotracheal tube and changing to non-invasive mechanical ventilation mode were carried out until weaning when reaching respectively undermentioned standards： reaching 15 points of GCS score, appearing of window period and being kept for 2 hours in GCS group; achieving pulmonary infection control window （pulmonary infection was obviously controlled）in PIC group; after SBT succeeded in SBT group. The ventilation and oxygenation indexes before ventilating, the time of received invasive mechanical ventilation, total mechanical ventilation time, total hospital stay time, re-intubation rate and the incidence of ventilator-associated pneumonia （VAP） were dynamically observed in three groups. Results The invasive ventilation time, the total mechanical ventilation time and the total hospital stay time in GCS group were all shorter than those in the other two groups （ all P 〈 0.05 ）. The invasive ventilation time, the total mechanical ventilation time and the total hospital stay time in PIC group were all shorter than those in SBT group （ all P 〈 0.05 ）. The incidences of VAP in GCS group and PIC group were all lower than that in SBT group （ all P 〈 0.05 ）, but there was no significant difference in the two groups（ P 〉 0.05 ）. There were no significant differences in the re-