有创无创序贯机械通气在治疗慢性阻塞性肺疾病所致呼吸衰竭中的应用

目的评价有创无创序贯机械通气在治疗慢性阻塞性肺疾病(COPD)所致呼吸衰竭中的应用价值。方法收集30例AECOPD合并严重Ⅱ型呼衰行气管插管有创机械通气患者作为序贯通气组,当肺部感染控制窗出现时,直接拔管序贯无创通气。另收集30例同样患者作为常规通气组,当肺部感染控制窗出现时,继续有创通气。观察2组撤机成功率、呼吸机相关肺炎(VAP)发生率、有创通气时间、总通气时间、住ICU时间、再插管率、死亡率及序贯通气组心率、呼吸、血压(收缩压)、pH值、PCO2、氧合指数变化。结果序贯通气组VAP发生率、死亡率、有创通气时间、总通气时间少于常规通气组(P﹤0.05),脱机成功率高于常规通气组(P﹤0.05),再插管率与常规通气组比较差异无统计学意义(P﹥0.05)。序贯通气组接受无创通气后的pH值、氧分压、二氧化碳分压、氧合指数、心率、呼吸频率、血压与拔管时比较无明显变化(P﹥0.05)。结论有创无创序贯机械通气协助撤机治疗AECOPD合并严重Ⅱ型呼衰患者较之常规方法撤机,可明显缩短撤机时间提高撤机成功率。

Application of invasive-noninvasive sequential ventilation in the treatment of severe respiratory failure patients withCOPD

Objective To evaluate the value of invasive-noninvasive sequential ventilation in the treatment of severe respiratory failure patients with COPD. Methods 30 cases of severe hypercapnic respiratory failure with AECOPD were collected as an invasive-noninvasive sequential ventilation group. When pulmonary infection control（PIC） window appeared, the early extuhation was conducted immediately and followed by noninvasive ventilation. Another 30 eases with similar clinical character- istics were compared as a conventional ventilation group. When P]C window appeared, the invasive ventilation continued. The weaning successful rate, VAP incidence rate, reintubation rate, mortality rate, noninvasive ventilation time, total ventilation time, the duration of ICU stay were observed in the two groups and changes of heart rate, respiratory rate , blood pressure and arterial blood gas were observed in sequential ventilation group. Results The VAP incidence rate, mortality rate, noninvasive ventilation time, total ventilation time in sequential ventilation group were lower than thost in the conventional group （ P 〈 0.05 ）. The weaning successful rate was higher than that in the conventional group { P 〈 0.05 ）. The reintubation rate was not different with that in the conventional group （ P 〉 0.05 ）. The changes of pH, PaO2, PaCO2, PaO2/FiO2, HR, RR and Bp in the sequential ventilation group were not significant （ P 〉 0.05 ）. Conclusion The result of sequential invasive-noninvasive ven- tilation is better than that of invasive ventilation for hypercapnic respiratory failure with AECOPD. It can effectively decrease the invasive ventilation period and improve the weaninz successful rate.