有创后序贯无创机械通气治疗重度COPD呼吸衰竭患者疗效观察

目的探讨有刨与无创序贯机械通气在治疗COPD重症呼吸衰竭的效果。方法选择40例COPD呼吸衰竭患者，随机分为两组，20例为有刨与无创序贯治疗组，20例为对照组，常规有创通气，以PSV方式至撤机。观察有创通气时间、总机械通气时间，医院获得性肺炎，住院时间、治疗费用等的差异；结果序贯治疗组与对照组，有创通气时间分别是（8．03±1．68）d和（15．02±2．96）d，总机械通气时间分别是（11．38±3．25）d和（19．29±4．11）d，VAP发生例数分别是3例和17例，住院时间分别是（15．89±2．01）d和（26．21±1．57）d，治疗费用分别是（1．09±0．01）万元和（1．92±0．06）万元，两组间比较差异有显著差异性（P〈0．05）。结论对COPD重症呼吸衰竭病例，采用有创与无刨序贯机械通气治疗可降低有刨机械通气时间、减少VAP的发生，减少住院时间及住院费用。

Sequential mechanical ventilation in COPD patients with severe respiratory failure

Objective To estimate the effect of sequential non - invasive following short-term invasive mechanical ventilation （MV） on COPD patients with severe respiratory failure（RF）. Methods Forty COPD patients with severe RF were studied. 20 cases in the study group were treated by sequential non-invasive foLlowing shot-term invasive. The patients in the control group were treated by inva- sive MV continuously. The clinical indications were observed in two groups. Results The parameters for the study group and the control group were, respectively, as foLlows： The durations of invasive MV were （8.03 ± 1.68） d and （ 15.02 ±2. 96） d. The total durations of mechanical ventilation, were （11.38 ± 3.25 ） d and （19. 29 ± 4. 11 ） d. The incidence rates of VAP were 3/20 vand17/20. The dura- tions of hospital stay were （ 15. 89 ± 2. 01 ）d and （26. 21 ± 1.57） d. Expenses of hospital stay were （ 10. 9 ± 0.01 ） thousand yuan and （ 1.92 ± 0. 06） thousand yuan （ P 〈 0. 05 ）. Conclusions COPD patients with severe respiratory failure who received invasive ventilation or non-invasive ventilation at the time pulmonary infection can be basically controLled, which may decrease the incidence of VAP and expenses of hospitalization, shorten duration of ventilation and hospitalization.