有创-无创序贯机械通气治疗急性呼吸窘迫综合征38例分析

目的评价有创一无创序贯机械通气治疗急性呼吸窘迫综合征（ARDS）患者的应用价值。方法选择2004年1月至2009月1月间在我科进行机械通气的38例ARDS患者为研究对象，临床出现“ARDS控制窗标准”后，将所有患者随机分为有创-无创序贯治疗组（序贯组）和常规治疗组（对照组）。序贯组持续气道正压（CPAP）无创机械通气直至脱机；对照组则继续常规有创机械通气，比较两组患者总机械通气时间、住院时间、呼吸机相关性肺炎（VAP）发生率和患者的转归。结果序贯组和对照组各19例，出窗时间和出窗时情况差异无统计学意义（P〉0．05）；序贯组与对照组的总机械通气时间分别为（11±5）d和（18±7）d（P〈0．05）；ICU住院时间为（16±3）d和（24±7）d（P〉0．05）；VAP发生率分别为15．8％和42．1％（P〉0．05）；住院病死率分别为21．1％和47．4％（P〈0．05）。结论对ARDS气管插管机械通气的患者，以“ARDS控制窗标准”为切换时机，采用有创一无创序贯性机械通气治疗，可以缩短机械通气时间和住院时间，降低住院病死率，是一项值得推广的有效的机械通气策略。

The application of sequential invasive - noninvasive mechanical ventilation in 38 patients with ARDS

Objective To evaluatue the application of sequential noninvasJve ventilation following invasive mechanical ventilation in patients with ARDS by investigating the appearance of ARDS - control - window. Methods Thirty- eight patients with ARDS who received endotracheal invasive ventilation were randomly assigned to apply immedately CPAP after ARDS - control - window （ sequential group） and to continue invasive ventilation （ control group） at the time ARDS -control -window had appeared. The incidence of ventilator- associated pneumonia（VAP） , the mortality rate,duration of total mechanical ventilation and intensive care unit （ICU） stay were compared between sequential group and control group. Results The total mechanical ventilation time of sequential group （ 11±5 ） days was lower than those （18±7）days （ P 〈0.05） in control group patients,the incidence of VAP （15.8%） and the mortality rate （21.1%） in sequential group patients were significantly lower than those （42.1%and 47. 4%, P 〈0. 05 ,respectively） in control group patients. In sequential group patients, ICU stay of （ 16 ± 3） days which were shorter than those of control group patients （ 24 ± 7 ） days （ P 〈 0.05 ）. Conclusions At the time ARDS control window had appeared, patients receive invasive ventilation who are extubated promptly and apply CPAP immediately may decrease the incidence of VAP and mortality rate, shorten duration of total mechanical ventilation and ICU stay.