有创-无创序贯性机械通气治疗老年肺内源性急性呼吸窘迫综合征随机对照临床研究

目的 评价有创-无创序贯性机械通气治疗老年肺内源性急性呼吸窘迫综合征(ARDS)患者的疗效及可行性.方法 32例老年肺内源性ARDS患者被随机分为序贯治疗组及常规治疗对照组,每组16例.两组均建立人工气道,以辅助/控制模式+呼气末正压(PEEP)+间隙性控制性肺膨胀(SI)方式通气24 h,随病情改善改用同步间歇指令通气(SIMV)+压力支持通气(PSV)+PEEP的方式.待"ARDS控制窗"出现,序贯组改换为无创正压通气(NIPPV),以持续气道正压(CPAP)方式通气并逐渐脱离呼吸机;对照组以SIMV+PSV+PEEP常规方式脱机.动态观察两组患者的通气及氧合指标,记录有创和总机械通气时间、呼吸机相关性肺炎(VAP)发生情况及住呼吸重症监护病房(RICU)的天数.结果 两组患者治疗前血气分析结果相仿(P均>0.05);序贯组有创通气时间(4.6±1.0)d]、总机械通气时间(12.7±4.0)d]、住RICU时间(16±7)d]较对照组分别为(21.9±9.0)d、(21.9±9.0)d、(29±13)d]明显缩短,VAP发生率6.25%(1/16)]和病死率25.00%(4/16)]也较对照组分别为75.00%(12/16)、56.25%(9/16)]明显降低,差异均有统计学意义(P<0.05或P<0.01).结论 对老年肺内源性ARDS插管机械通气以ARDS控制窗为时机及时改用无创通气可显著改善其疗效.

Randomized control study of sequential non-invasive following short-term invasive mechanical ventilation in the treatment of acute respiratory distress syndrome as a result of existing pulmonary diseases in elderly patients

Objective To evaluate the feasibility and the efficacy of sequential non-invasive mechanical ventilation (MV) following short-term invasive MV in the treatment of acute respiratory distress syndrome (ARDS) consequent to pulmonary diseases in the elderly patients. Methods Thirty-two elderly patients of ARDS were enrolled and grouped into two groups (sequential therapy group and control group) randomly (16 cases in each group). Both groups with tracheal intubation received the following ventilation modality in the first 24 hours: control/assistant-control+positive end expiratory pressure (PEEP)+sustained inflation (SI), and when the patients' conditions were relieved, the ventilation modality was switched to synchronized intermittent mandatory ventilation (SIMV)+pressure support ventilation (PSV)+PEEP. When "ARDS-controlled window" appeared, the ventilation modility was switched to oronasal face continuous positive airway pressure (CPAP), followed by CPAP until weaning;the control group was weaned with SIMV+PSV+PEEP. The parameters including ventilation and oxygenation, ventilation duration, ventilation-associated pneumonia (VAP), duration of respiratory intensive care unit (RICU) stay were serially determined. Results Both groups had the similar baseline clinical characteristics (all P＞0.05). The patients in the sequential therapy group showed shorter MV duration (4.6±1.0) days], total duration of ventilation support (12.7±4.0) days] and RICU stay duration (16±7) days], and lower VAP incidence rate 6.25% (1/16)] and mortality rate 25.00% (4/16)] compared with control subjects (21.9±9.0) days, (21.9±9.0) days, (29±13) days, 75.00% (12/16), 56.25% (9/16), respectively, P<0.05 or P<0.01]. Conclusion Early extubation followed by non-invasive ventilation might decrease the total duration of ventilation support, the risks of VAP and duration of RICU stay.