有创—无创机械通气序贯疗法联合雾化吸入治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭的疗效观察

目的探讨有创—无创机械通气序贯疗法联合雾化吸入治疗慢性阻塞性肺疾病急性加重期(AECO-PD)合并严重呼吸衰竭的临床疗效。方法将AECOPD合并呼吸衰竭且需气管插管机械通气治疗的患者84例随机分为观察组42例和对照组42例。所有患者均给予抗感染、解痉、平喘、止咳、化痰、防治并发症、维持内环境稳定、营养支持等治疗,气管插管加用呼吸机用同步间歇强制通气+压力支持通气(SIMV+PSV)模式通气。在肺部感染控制窗出现后,观察组拔出气管插管,改用经鼻面罩无创通气模式,逐渐减低呼吸机支持参数,直至成功脱机;治疗间歇期给与α-糜蛋白酶4000U+庆大霉素8万U+地塞米松5mg+生理盐水10ml雾化吸入。对照组继续有创通气治疗,同样逐渐减低呼吸机支持力度直至脱机成功。记录2组脱机时心率、呼吸频率、动脉血氧分压(PaO2)、动脉血压二氧化碳分压(PaCO2)及pH值,比较2组患者有创通气时间、总通气时间、住院时间及呼吸机相关性肺炎(VAP)发生情况。结果观察组有创通气时间、总通气时间、住院时间均短于对照组,差异均有统计学意义(P<0.05)。观察组VAP发生率为7.1%低于对照组的35.7%,差异有统计学意义(P<0.05)。结论有创—无创序贯性机械通气治疗AECO-PD,可缩短有创通气时间及住院时间,减少VAP发生率,值得临床推广应用。

Efficacy observation of invasive-non-invasive mechanical ventilation sequential therapy combined with aerosol inhalation in acute exacerbation of chronic obstructive pulmonary disease with respiratory failure

Objective To investigate the clinical efficacy of invasive-non-invasive mechanical ventilation sequential therapy combined with aerosol inhalation in acute exacerbation of chronic obstructive pulmonary disease（AECOPD） with respiratory failure.Methods 84 cases patients with CAEOPD combined respiratory failure and required intubation and mechanical ventilation were randomly divided into observation group（42 cases） and control group（42 cases） .All patients were given anti-infection,spasm,asthma,cough,phlegm,prevent complications,maintain homeostasis,nutritional support,treatment,trachea intubation-add breath-ing mach-ine synchronized intermittent mandatory ventilation＋with pressure support ventilation（SIMV＋PSV） mode of ventilation.In the pulmonary infection control window appears,unplug the observed of endotracheal intubation,used non-invasive nasal mask ventilation,and gradually reduce ventilator support parameters,until a successful off-line.Control group continued invasive ventilation,also gradually reduced ventilator support until the off-line success.Recorded off-line heart rate,respiratory rate,arterial oxygen pressure（PaO2） ,arterial blood pressure of carbon dioxide partial pressure（PaCO2） and pH of two groups,compared invasive ventilation time,the total mechanical ventilation time,length of stay and the incidence of ventilator-associated pneumonia（VAP） .Results Invasive ventilation time,the total mechanical ventilation time,length of stay of observation group were shorter than those of control group,there were significant difference（P0.05） .The incidence of VAP of observation group（7.1%） was lower than that of control group（35.7%） ,the difference was statistically significant（P0.05） .Conclusion Invasive-non-invasive mechanical ventilation sequential therapy in AECOPD,can reduce the invasive ventilation time and length of stay,reduce the incidence of VAP,is worthy of clinical application.