有创-无创序贯机械通气治疗AECOPD的临床观察

目的探讨慢性阻塞性肺疾病急性加重（AECOPD）的患者应用有创-无创序贯机械通气的治疗效果。方法在已实施气管插管机械通气治疗的AECOPD患者30例中，随机选取15例患者为序贯治疗组（A组），待“肺部感染控制窗”出现，拔除气管插管，改为经面罩BiPAP无创通气，渐至脱机；另选15例为对照组（B组），行常规有创通气，最后以PSV方式至撤机，比较两组病例治疗前后各项指标：有创通气时间、VAP发生例数、住院时间、撤机成功例数、院内死亡例数、住院费用。结果有创通气时间：A组（10±3）d，B组（18±3）d；VAP发生例数：A组2例，B组8例；住ICU时间：A组（12±3）d，B组（22±6）d；撤机成功例数：A组14例，B组5例；院内死亡例数：A组3例，B组10例；治疗费用：A组（2．5±0．2）万元；B组（4．8±1．8）万元。两组比较差异均有统计学意义（P〈0．05）。结论AECOPD患者，有创-无创序贯机械通气方法可明显提高治疗效果。

Effective of Sequential Non - invasive Following Short - term Invasive Mechanical Ventilation （MV） on AECOPD Patients

Objective To explore the effect of sequential non - invasive flowing short - term invasive mechanical ventilation on patients with AECOPD （acute exacerbations of chronic obstructive pulmonary disease）. Methods 30 AECOPD patients were stochastically divided into two groups：A group （study group）was treated by sequential non -invasive following short-term invasive mechanical ventilation when pulmonary infection had been controlled （we call the time as＂ pulmonary infection control window＂, PIC window）. B group （control group）was treated by invasive MV continuously. Results Two groups had similar clinical characteristics （ age and blood - gas analysis）, For study group and control group, the duration of invasive MV was（ 10 ± 3）days VS（ 18 ± 3 ）days, the incidence of VAP were 2 cases VS 8cases, the duration of hospitalization was（ 12 ± 3） VS（22 ±6） days,the incidence of weaning MV was 14 VS 5 ,the medical expense was（2. 5±0. 2） VS（4. 8 ± 1.8）ten thousand yuan. There was significant difference （ P 〈 0. 01 ） between the groups. Conclusions In AECOPD patients, Sequential non - invasive following short -term invasive mechanical ventilation can improve the curative effect.