有创-无创序贯性机械通气治疗慢性阻塞性肺疾病重症呼吸衰竭的疗效研究

目的评价有创-无创序贯性机械通气在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)重症呼吸衰竭患者治疗中的作用,并评价以肺部感染控制窗(pulmonary infection control windows,PIC窗)为切换点转换通气模式的效果。方法选择2005年4月～2007年4月入住南昌大学第一附属医院呼吸科监护病房(RICU)的36例COPD重症呼吸衰竭患者,均接受了气管插管和机械通气,通气模式为同步间歇指令通气 压力支持通气 呼气末正压(SIMV PSV PEEP),随机分为观察组(H组,n=18)和对照组(C组,n=18),H组在PIC窗出现后拔除气管插管,改用经鼻(面)罩双水平正压通气(BiPAP),逐渐减低PSV水平直至脱机;C组在PIC窗出现后继续进行有创机械通气,并逐渐减SIMV频率及PSV水平至脱机。观察2组的有创和总机械通气时间、呼吸机相关肺炎(ventilator associated pneumonia,VAP)发生率、再插管率、入住RICU的时间和病死率。结果H组的有创机械通气和总机械通气时间较C组显著缩短(P<0.05),VAP发生率明显减少(P<0.05),缩短了入住RICU的时间(P<0.05);2组的再插管率和病死率无显著差别(P>0.05)。结论对于COPD重症呼吸衰竭患者,以PIC窗为切换点,实施有创-无创序贯性机械通气,能收到良好的治疗效果。

Effects of sequential non-invasive following short-term invasive mechanical ventilation in COPD induced severe hypercapnic respiratory failure

Objective To estimate the effects of sequential non-invasive following short-term invasive mechanical ventilation in COPD induced severe respiratory failure, and investigate the swith-point of pulmonary infection control(PIC)windows.Methods 36 COPD cases with severe hypercapnic respiratory failure in the first attached hospital of Nanchang university from 2005-04 to 2007-04 were involved in the study.All the cases had been intubated and received mechanical ventilation.They were randomized into group H and group C.18 cases (group H) had been extubated and followed by non-invasive mechanical ventilation via facial mask after the appearance of PIC windows.Other 18 cases (group C)received invasive mechanical ventilation continuously after the appearance of PIC windows.Observed the duration of ventilation support,the ratio of ventilator associated pneumonia(VAP)and reintubaion,the length of RICU stay and mortality.Results Two groups had similar clinical characteristics before treatment.Group H had the shorter duration of total ventilation support and the length of RICU stay(P<0.05),and the ratio of VAP was lower than Group C(P<0.05).There was no difference between the two groups for the ratio of reintubaion and mortality.Conclusion For COPD patients with severe hypercapnic respiratory failure, early extubation followed by non-invasive mechanical ventilation at the point of PIC windows may get the better effect.