序贯有创-无创机械通气在AECOPD合并Ⅱ型呼吸衰竭中的应用

目的探讨序贯有创一无创机械通气在慢性阻塞性肺疾病急性加重期（AECOPD）合并二型呼吸衰竭中的应用。方法随机选取我院2009年5月-2012年5月诊治的AECOPD合并Ⅱ型呼吸衰竭患者80例，随机分为两组各40例，在吸氧、抗炎、解痉等常规治疗基础上分别给予常规有创机械通气和序贯机械通气治疗，观察两组主要通气指标及治疗前、后动脉血气指标等变化。结果序贯机械通气组有创通气时间显著缩短，呼吸机相关性肺炎（VAP）发生率和再插管率均明显降低，与常规有创机械通气组比较，差异具有统计学意义（P均〈0．05），但两组总通气时间无统计学差异（P=0．08）；序贯机械通气组动脉血pH值、PaCO2和PaO2较治疗前和常规有创机械通气组均明显改善，差异具有统计学意义（P均〈0．05）。结论序贯有创一无创机械通气治疗AE-COPD合并Ⅱ型呼吸衰竭的临床疗效更显著，改善患者呼吸功能和降低VAP发生率。

Application of sequential invasive and non-invasive ventilation in treatment of AECOPD combined with type II respiratory failure

Objective To observe the effect of sequential invasive and non-invasive ventilation in treatment of AE- COPD combined with type II respiratory failure. Methods Eighty patients with AECOPD combined with type II respiratory failure in our hospital were randomly selected and divided into two groups. All of received convention treatment such as oxygen, anti-inflammatory, spasmolysis, and given with sequential invasive and non-invasive ventilation and convention ventilation respectively in the two groups. The main ventilation index and arterial blood gas before and after treatment were compared. Results The time of invasive ventilation, the rate of VAP and reintubation in sequential invasive and non-invasive ventilation group were significant shorter than invasive ventilation group （P 〈 0.05）, but it was insignificant of total ventilation time in the two groups（P = 0.08）. The sequential invasive and non-invasive ventilation group showed significantly improvement in arterial blood pH, PaCO2 and PaO2 compared with invasive ventilation group（P 〈 0.05）. Conclusion The treatment of sequential invasive and non-invasive ventilation has more clinical effect, improved the respiratory function and reduce the incidence of VAP.