有创-无创序贯机械通气治疗AECOPD合并严重呼吸衰竭临床观察

目的观察有创-无创序贯机械通气治疗慢性阻塞性肺疾病（AECOPD）合并严重呼吸衰竭的临床效果，探讨其优越性。方法随机选取21例AECOPD合并严重呼吸衰竭患者予有创后脱机拔除气管插管序贯无创机械通气治疗，19例采用传统有创机械通气治疗，记录并分析比较两组间患者治疗初基础情况和在有创机械通气时间、住呼吸重症监护病房时间、总的机械通气时间、总住院时间，及呼吸机相关性肺炎（VAP）发生率、再插管率等。结果有创-无创序贯机械通气治疗AECOPD合并严重呼吸衰竭疗效显著，有创通气时间、住呼吸重症监护病房时间、总住院时间序贯组较传统组均缩短P〈0.05，VAP发生率、再插管率均低于传统组P〈0．05。结论在患者支气管-肺部感染控制好转，痰液性状改善情况下停有创，序贯无创治疗具有优越性。

The effect of clinical study in agencied COPD insulting severe respiratory failure by using sequential invasive and nou-invasive mechanical ventilation

Objective To observe the clinical therapeutic effect of sequential invasive and non - invasive mechanical ventilation in agencied COPD insulting severe respiratory failure and to explore the superiority of sequential mechanical ventilation. Methods 21 patients with agencied COPD insulting severe respiratory failure were randomly selected, who underwent sequential invasive and non-invasive mechanical ventilation. 19 patients underwent conventional invasive mechanical ventilation treatment. The measured were recorded and analyzed and compared of the basics of patients before treatment and the invasive mechanical ventilation time, the stayed RICU time, total mechanical ventilation time, total length of stay in hospital time; the incidence of ventilator associated pneumonia （VAP）, and incidence of repeated tracheal intubation. Results Sequential invasive and non-invasive mechanical ventilation in agencied COPD insulting severe respiratory failure has significant therapeutic effect on shortening the invasive mechanical ventilation time, the stayed RICU time and total length of stay in hospital time （ P 〈0.05 ）. The incidence of ventilator associated pneumonia （VAP） , and incidence of repeated tracheal intubation in sequential invasive and non-invasive mechanical ventilation was lower than that using conventional treatment （P 〈 0. 05 ）. Conclusion After infection of the bronchia and lung were controlled, and the character of phlegm had improved, sequential invasive and non-invasive mechanical ventilation had superiority.