序贯机械通气治疗在慢性阻塞性肺疾病呼吸衰竭撤机中的应用价值研究

目的 探讨序贯机械通气治疗在慢性阻塞性肺疾病(COPD)合并呼吸衰竭中作为撤机方式的应用价值.方法 将40例患者随机分为序贯治疗组(20例)和对照组(20例),对两组患者各个时间点的动脉血pH、PaO_2及PaCO_2进行比较,观察治疗前后的变化;观察两组患者有创机械通气时间、呼吸机相关性肺炎发生例数、总机械通气时间、住院时间、监护时间、撤机成功例数、住院费用和院内死亡例数.结果 两组的动脉血pH、PaO_2及PaCO_2在治疗后24 h和72 h均有所改善(P<0.05).序贯治疗组的有创通气时间、总机械通气时间、呼吸机相关性肺炎发生率、总住院时间、监护时间、医疗费用等优于对照组(P<0.05).撤机成功例数序贯治疗组17例,对照组14例,两组比较差异无统计学意义.结论 序贯机械通气是一种有效的治疗COPD合并Ⅱ型呼吸衰竭的手段和撤机方式.

Application value of sequential mechanical ventilation in extubation in patients with respiratory failure due to chronic obstructive pulmonary disease

Objective To evaluate the application value of sequential mechanical ventilation in chronic obstructive pulmonary disease(COPD)patients with type-Ⅱ respiratory failure.Methods Forty patients with COPD and type-Ⅱ respiratory failure were randomly divided into treatment group of sequential mechanical ventilation(20 cases)and control group(20 cases).Arterial blood pH,PaO_2 and PaCO_2 at every time point were measured and compared between the two groups,the changes before and after the treatment were observed.The duration of invasive mechanical ventilation,total mechanical ventilation,hospitalization and care,the cases of ventilator-associated pneumonia and successful extubation,cost of hospitalization and cases of death in hospital were compared between treatment group and control group.Results Arterial blood pH,PaO_2 and PaCO_2 of the two groups improved after the treatment for 24 hours and 72 hours(P ＜0.05).Compared with control group,treatment group had shorter duration of invasive mechanical ventilation and total mechanical ventilation,lower incidence of ventilator-associated pneumonia,fewer days of hospitalization and care,and fewer cost of hospitalization(P ＜0.05).The cases of successful extubation were 17 in treatment group and 14 in control group.Conclusions Sequential mechanical ventilation is an effective extubation method for COPD patients with type-Ⅱ respiratory failure.