应用纤维支气管镜辅助慢性阻塞性肺疾病机械通气序贯撤机

目的观察应用纤维支气管镜辅助慢性阻塞性肺疾病机械通气序贯撤机的临床疗效。方法将慢性阻塞性肺疾病（COPD）并发呼吸衰竭行气管插管机械通气者随机分为应用纤维支气管镜辅助有创一无创序贯机械通气撤机组（A组，38例）和有创一无创序贯机械通气撤机组（B组，36例），比较两组病例出现肺部感染控制窗（PIC）时间、有创机械通气时间、总机械通气时间、呼吸机相关肺炎（VAP）发生率、首次撤机成功率、RICU住院时间、住院病死率、住RICU费用及住院总费用等指标。结果A组和B组出现PIC时间分别为（6．0±2．5）d、（8．4±3．6）d，有创机械通气时间分别为（6．3±2．7）d、（8．6±3．5）d，总机械通气时间分别为（9．7±2．8）d、（12．7±4．1）d，住RICU时间分别为（7．9±2．8）d、（10．7±3．5）d，两组指标比较，差异有统计学意义（P〈0．01）；首次撤机成功例数分别为38、30，总住院费用分别为（28794±14618）元、（38746±22916）元，住RICU费用分别为（25936±12663）元、（35347±21696）元，两组指标比较，差异均有统计学意义（P〈0．05）；A组无一例发生VAP，B组发生4例，A组死亡1例，B组死亡2例，未达到统计学意义。结论应用纤维支气管镜辅助慢性阻塞性肺疾病机械通气序贯撤机能进一步缩短有创通气时间，能取得更好的临床疗效，而且是更经济的治疗方法。

Weaning from mechanical ventilation by sequential invasive to noninvasive ventilation assisted with fiberoptic bronchscopy in patients with COPD

Objective To observe the efficacy of ventilator weaning in patients with chronic obstructive pulmonary diseases （COPD） by sequential invasive to noninvasive ventilation assisted with fiberoptic bronchscopy. Methods The cases were randomly divided into the study group（ group A, n = 38 ） and the control group （ group B, n = 36 ）. In group A,patients were treated with hronchoscope combined with sequential noninvasive following invasive mechanical ventilation. In group B, patients were treated with sequential noninvasive following invasive mechanical ventilation. To compare initial time of pulmonary infection control window （PIC window） , the invasive MV duration, the total duration of vcntilatory support, the duration of RICU, the successful rate of weaning, hospitalization expenses, mortality rate and the incidence of ventilation - associated pneumonia（ VAP）. Results For group A and group B,the initial time of PIC window was（ 6.0 ±2.5） vs （8.4 ±3.6） d, P 〈0.01 ;the duration of invasive MV was（ 6.3 ±2.7） vs （8.6 ±3.5 ） d, P 〈 0.01 ; the total duration of ventilatory support was （ 9.7 ± 2.8 ） vs（ 12.7 ± 4.1 ） d, P 〈 0.01 ; the durationofRICU stay was（7.9±2.8）d vs（10.7 ± 3.5）d, P 〈0. 01;the successful rate of weaning （ 38/38 ） vs（30/36） , P 〈 0.05 ; the total hospitalization expenses was （ 28 794 ± 14 618 ） yuan vs （ 38 746 ± 22 916）yuan, P 〈0.05;the RICU expenses was （25 936 ± 12 663） yuan vs（35 347 ±21 696） yuan, P 〈0.05. No significant difference in the incidence of VAP and mortality rate. Conclusions The therapy of weaning from mechanical ventilation by sequential invasive to noninvasive ventilation assisted with fiberoptic bronchscopy is effective in patients with COPD. It may decrease the duration of invasive MV and hospitalization expenses.