序贯机械通气护理治疗慢性阻塞性肺疾病伴严重呼吸衰竭的效果评价

目的：探讨有创-无创序贯机械通气（NIPPV）护理在慢性阻塞性肺疾病（COPD）伴严重呼吸衰竭患者中的应用效果。方法：76例COPD并伴有呼吸衰竭患者随机分为NIPPV护理组（序贯组）和有创通气护理对照组（对照组），每组38例。分别给予2组患者同样剂量的抗感染、去咳化痰及稳定水电解质酸碱平衡等常规治疗，对照组患者应用有创机械通气护理，序贯组以肺部感染时间窗（PIC窗）作为有创-无创的时间切换点，采用NIPPV护理处理。比较2组患者ICU住院时间、呼吸机相关性肺炎（VAP）发生率、血气指标、有创通气时间、总机械通气时间等。结果：2组患者ICU住院时间、VAP发生率、血气指标、有创通气时间、总机械通气时间差异均有统计学意义（P＜0.05）。结论：以PIC窗作为切换点的NIPPV护理治疗COPD伴有呼吸衰竭患者，可缩短有创机械通气时间，降低VAP的发生率，缩短入住ICU时间。

The nursing effect of noninvasive-invasive mechanical ventilation on COPD patients with severe respiratory failure

Objective: To evaluate the nursing effect of withdrawing artificial airway catheter in the sequential treatment by invasive or non-invasive mechanical ventilation on chronic obstructive pulmonary disease (COPD) patients with severe respiratory failure. Methods: Two groups of patients (76 cases) were given the same dose of anti-infection, cough and phlegm treatment and stable water electrolyte acid-base balance. The control group (38 cases) was treated with invasive mechanical ventilation (IPPV), and the sequential group (38 cases) was used as an noninvasive-invasive mechanical ventilation (NIPPV) when catheter was removed. Results: The time of ICU hospitalization, the number of cases of mechanical ventilation associated pneumonia (VAP), the vigor of the two groups, the time of invasive ventilation, and the total mechanical ventilation time were found to be significantly different between the two groups. Conclusion: The invasive and noninvasive sequential mechanical ventilation using PIC window as a switching point for patients with COPD with respiratory failure can shorten the duration of invasive mechanical ventilation, the number of VAP cases and the time of ICU occupancy.