有创-无创序贯机械通气救治非COPD急性严重呼吸衰竭的护理

目的：探讨有创一无创序贯机械通气救治非COPD病因所致急性严重呼吸衰竭的临床效果及护理。方法：选择非COPD病因所致急性严重呼吸衰竭患者20例为序贯通气组，先经口气管插管有创通气，根据病情在3～7d内拔除气管插管改为无创正压通气；选择相似病情病例20例作为对照组，经Kr气管插管有创通气，以同步间歇强制通气＋压力支持通气方式撤机。对2组患者均进行密切观察、精心护理以配合治疗。观察两组病例的机械通气时间、呼吸机相关性肺炎（VAP）发生率、撤机成功率、住院死亡率、总住院时间等，并对护理资料进行分析。结果：序贯通气组VAP发生率、有创通气时间、总机械通气时间、总住院时间明显低于对照组（P〈0．05）。结论：有创一无创序贯机械通气策略不仅可应用于COPD所致的重症呼吸衰竭，结合有效的护理措施，对非COPD病因所致急性严重呼吸衰竭的救治也具有一定优势。

Nursing care of sequential invasive to noninvasive mechanical ventilation in treatment of none COPD severe respiratory failure

Objective： To evaluate the clinic efficacy and nursing experience of sequential invasive to noninvasive mechanical ventilation （MV） in treatment of none COPD severe respiratory failure. Methods： 20 patients with none COPD severe respiratory failure due to different causes were assigned to the sequential therapy group. After 3-7 days intubation and invasive positive pressure MV, the extubation was conducted and followed by noninvasive MV. Other 20 cases with similar clinic characteristics who continuously re- ceived invasive MV were assigned to control group, then the duration of MV, the incidence of ventilator-associated pneumonia （VAP）, the incidence of death, total hospitalization time were compared and the data of nursing was analyzed. Results： The patients in the sequential therapy group showed less incidence of VAP, invasive MV duration, total MV duration, and total hospitalization time compared to control subjects （P〈0. 05）. Conclusion： Combined with effective nursing intervention, sequential invasive to noninvasive MV strategy not only could be used in treatment of severe respiratory failure of COPD, but also could be used in treatment of severe respiratory failure caused by none COPD.