Objective:To compare the safety and curative effect of the invasive and noninvasive consequent ventilation indicator for the patients with chronic obstructive pulmonary disease (COPD) combined with respiratory failure by using Glasgow coma scale (GCS), and explore its clinical application value.Methods: 60 gerontal patients with COPD combined with respiratory failure were divided into control group (32 cases, cured time from January 2010 to June 2013) and observation group (28 cases, cured time from June 2013 to June 2016). The patients of control group were treated by using from continuous invasive ventilation to gradually separate from ventilator. The patients of observation group were extubated trachea cannula when the GCS achieved or exceeded standard score, 10 score. The synchronous intermittent mandated ventilation combined with pressure support ventilation (PSV) at GCS<10 were changed to noninvasive ventilation mode (bi-level positive airway pressure ventilation) at GCS≥10. The differences of a series of indicators, such as blood-gas analysis, positive end expiratory pressure, invasive ventilation time, ventilator-associated pneumonia (VAP) and hospitalization between the two groups were observed and analyzed.Results: The differences of blood-gas analysis between before and after trachea cannula was extubated for both of observation group and control group were no significant (x2=1.506,x2=1.274;P>0.05), respectively. While the PSV of observation group was significant higher than that of control group (x2=3.642,x2=2.652;P<0.05), and the invasive ventilation time of observation group was significant lower than that of control group (x2=6.243,P<0.05). Duration of therapy, there was 1 cases with VAP in observation group, and there were 7 cases with VAP in control group, the difference of VAP between the two groups was significant (x2=12.563,P<0.05).Conclusion: GCS≥10 are selected as the critical point and it can be used as indicator of invasive and noninvasive consequent ventilation for patients with COPD combined with respiratory failure to guide in extubating trachea cannula at clinical early stage, and it contribute to improve rehabilitation of patients and reduce the occurrence of relevant disease.%目的:通过格拉斯哥昏迷量表(GCS)评分≥10为临界对慢性阻塞性肺疾病(COPD)合并呼吸衰竭的患者作有创-无创序贯通气指标的临床应用安全性及疗效比较,探讨其临床应用价值.方法:选择医院收治的60例患有COPD合并呼吸衰竭的老年患者的临床资料,按照收治时间将2010年1月至2013年6月收治的患者纳入对照组(32例);将2013年6月至2016年6月收治的患者纳入观察组(28例).对照组患者采用持续行有创通气方案至逐步脱离呼吸机的治疗方法;观察组患者以GCS=10分时为标准拔除气管插管,将GCS<10分时同步间歇指令+压力支持通气(SIMV+PSV)改为GCS≥10时双水平气道正压通气的无创通气方式,观察患者血气分析结果及呼气末正压;观察两组患者在有创通气时间、呼吸机相关肺炎、住院情况方面的差异.结果:观察组患者与对照组患者在拔除插管前后比较血气分析指标不明显,差异无统计学意义(x2=1.506,x2=1.274;P>0.05);但PSV水平比较观察组明显高于对照组的有创机械通气水平,差异有统计学意义(x2=3.642,x2=2.652;P<0.05);观察组患者少于对照组患者有创机械通气时间,差异有统计学意义(t=6.243,P<0.05);治疗期间观察组出现呼吸机相关性肺炎(VAP)1例,对照组患者出现7例,两组比较差异有统计学意义(x2=12.563,P<0.05).结论:以GCS评分≥10为临界,对COPD并呼吸衰竭的患者作有创-无创序贯通气指标可以指导临床早期拔管,利于改善患者恢复状况及减少相关疾病发生.
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