序贯机械通气治疗48例慢性阻塞性肺疾病呼吸衰竭的临床体会

目的：探讨有创与无创序贯机械通气策略治疗慢性阻塞性肺疾病（COPD）呼吸衰竭的技术可行性及疗效。方法：对48例COPD呼吸衰竭患者进行气管插管机械通气治疗，待肺部感染明显控制后，随机分为无创序贯治疗组（A组）和有创通气组（B组），每组24例。A组治疗方法：拔出气管插管，改用经鼻面罩压力支持通气＋呼气末正压（PSV＋PEEP）通气，逐渐减低PSV水平直至脱离呼吸机。B组治疗方法：继续按常规有创机械通气方法治疗，以目前临床常用压力支持通气（PSV）模式脱机。观察两组患者有创通气时间、呼吸机相关肺炎发生例数、总机械通气时间、住院时间、监护时间、病死率等。结果：两组患者发生呼吸机相关肺炎的例数分别为1例（4．16％）和9例（37．50％）（P〈O．05），总机械通气时间分别为（9．32±1．87）d和（15．36±2．161d（P〈0．05），住院时间分别为（15．85±2．72）d和（25．12±3．121d（P〈0．05）。结论：有创通气及肺部感染明显控制后的无创序贯性通气治疗方法，可以明显缩短机械通气时间，降低呼吸机相关肺炎的发生率，缩短重症监护和总住院时间，显著改善治疗效果。

Therapeutic effects of sequential mechanical ventilation on 48 COPD patients with severe respiratory failure

Objective：To evaluate the efficacy of sequential non-invasive following invasive mechanical ventilation in COPD patients with severe respiratory failure. Methods ：Forty-eight COPD patients with severe respiratory failure were studied.After controlling pulmonary infection,24 patients（sequential treatment group A）were extubated and treated by non-invasive mechanical ventilation,24 cases（invasive ventilation group B）were kept treating by invasive mechanical ventilation and weaned by PSV mode.The duration of invasive mechanical ventilation,total mechanical ventilaiton,hospitalization and care, the incidence of ventilator associated pneumonia were compared between two groups. Results：For treatment group and control group, the incidence of ventilator associated pneumonia was 4.16%（1 case） vs 37.50%（9 cases）（P〈0.05）, the total duration of mechanical ventilation was （9.32±1.87）d vs （15.36±2.16）d（P〈0.05） and the dura- tion of hospitalization was （15.85±2.72）d vs （25.12±3.12）d（P〈0.05） respectively.Conclusion：Sequential non-invasive following invasive mechanical ventilation after pulmonary infection control may significantly shorten the duration of mechanical ventilation and hospitalization, reduce medical expense and the frequency of ventilator associated pneumonia, and enhance the rescue success rate.