有创与无创序贯机械通气治疗慢性阻塞性肺疾病重症呼吸衰竭

目的探讨有创与无创序贯机械通气治疗慢性阻塞性肺疾病（COPD）重症呼吸衰竭的方法与疗效。方法对40例COPD重症呼吸衰竭患者进行气管插管机械通气治疗，达到肺部感染控制窗（PIG窗）后，随机分为序贯治疗组和对照组，每组20例。序贯组治疗方法：立即拔出气管插管，改用口鼻面罩双水平气道正压通气（BiPAP）。对照组治疗方法：继续按常规有创机械通气方法治疗，以目前临床常用压力支持通气（PSV）模式脱机、2组同时进行监护，观察2组患者有创通气时间、呼吸机相关肺炎（VAP）发生例数、总机械通气时间、住院时间、监护时间、病死率等。结果2组患者发生VAP的例数分别为1例（5％）和8例（40％）（P〈0．05），总机械通气时间分别为（10．4±2．5）d和（15．3±3．2）d（P〈0．05），住院时间分别为（16．2±2．8）d和（25．8±4．2）d（P〈0．01）。结论在PIC窗指导下的有创与无创序贯性通气治疗方法，可以明显缩短机械通气时间，降低VAP发生率，缩短重症监护（ICU）和总住院时间，改进治疗效果，降低治疗费用，提高抢救成功率。

Sequential non-invasive following short-term invasive mechanical ventilation in COPD patients with severe respiratory failure

Objective To evaluate the efficacy of sequential non-invasive following short-term invasive mechanical ventilation in COPD patients with severe respiratory failure. Methods Forty COPD patients with severe respiratory failure were studied. When pulmonary infection had been controlled, 20 patients（treatment group）were extubated and treated by non-invasive mechanical ventilation ,20 cases （control group）were kept treating by invasive mechanical ventilation and weaned by PSV mode. The duration of invasive mechanical ventilation, total mechanical ventilaiton, hospitalization and care,the incidence of ventilator-associated pneumonia（VAP） were compared between two groups. Results For treatment group and eontrol group,the incidence of VAP was 5% （ 1 case） vs 40% （8 cases） （P 〈0.05） ,the total duration of mechanical ventilation was 10.4 ±2. 5 d vs 15.3 ±3.2 d （P〈0. 05） and the duration of hospitalization was 16. 2 ±2. 8 d vs 25.8 ±4. 2 d （P 〈 0. 01 ） respectively. Conclusions Sequential non-invasive following invasive mechanical ventilation at the time of pulmonary infection control（ PIC ） window may significantly shorten the duration of mechanical ventilation and hospitalization, reduce medical expense and the frequency of VAP, and enhance the rescue success rate.