有创-无创序贯机械通气治疗在COPD急性加重期的应用

目的探讨有创-无创机械通气在慢性阻塞性肺疾病急性加重期（AECOPD）中的疗效。方法将符合条件的36例AECOPD患者随机平均分为两组。在“肺部感染控制窗（PIC窗）”出现时，治疗组给予有创-无创序贯机械通气，对照组常规给予有创机械通气，观察两组患者生理指标、呼吸机相关肺炎（VAP）、机械通气时间、住院时间、住院死亡数等。结果治疗组及对照组患者发生VAP的例数分别为1例和8例（1／18，8／18，P〈0．05），有创通气时间为（5．56±0．37）d和（12．50±1．18）d（P〈0．01），总机械通气时间为（8．50±0．41）d和（12．50±1．18）d（P〈0．01）；住院时间为（11．41±0．84）d和（17．72±0．98）d（P〈0．01）；两组患者生理指标、住院死亡率无明显差异（P〉0．05）。结论在肺部感染控制窗将有创机械通气改为无创机械通气，可显著降低有创机械通气和总机械通气时间，减少VAP的发生，减少住院时间，可明显提高治疗效果。

Application of sequential non-invasive following short-term invasive mechanical ventilation in patients with AECOPD

Objective To study the efficacies of sequential non-invasive following short-term invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD）. Methods Thirty-six AECOPD patients intubated were randomly divided into two groups, each group having 18 cases. The study group was treated with sequential non-invasive following short-term invasive mechanical ventilation when pulmonary infection had been controlled（ PIC window）, and the control group was treated with invasive mechanical ventilation continually. And the changes of the clinical characteristics, the incidence of ventilators-associated pneumonia（VAP） and deaths, the duration of mechanical ventilation, days in hospital were compared. Results Compared with the control group, the study group had lower rate of VAP （1/18,8/18, P 〈 0.05）, shorter duration of invasive mechanical ventilation （ 5.56 ± 0.37） d, （ 12.50 ±1. 18） d, P 〈 0.05 ], shorter duration of total mechanical ventilation （8.50 ± 0.41 ） d, （ 12.50 ± 1.18） d, P 〈 0.05 ], and fewer days in hospital （ 11.41 ± 0.84 ） d, （ 17.72 ± 0.98） d, P 〈 0.05 ]. There was no significant difference in the clinical characteristics and mortality in hospital between these two groups （ P 〉0.05 ）. Conclusion In paitents with AECOPD requiring intu bation, sequential non-invasive following short-term invasive mechanical ventilation can significantly improve the curative effect, at the point of PIC window.