以降钙素原窗指导有创与无创序贯机械通气治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭的研究

摘要

Objective To evaluate the feasibility and the efficacy of early extubation and sequential noninvasive mechanical ventilation (MV) switched by procalcitonin window ( PTC window) in chronic obstructive pulmonary disease with exacerbated hyercapnic respiratory failurel.Methods All selected acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with respiratory failure were randomly divided into two groups.Sequential MV group by PIC window were the control group (22 cases),and others (23 cases) were as the experimental group underwent sequential MV by PTC window.The invasive MV duration,days of invasive MV,ventilatorassociated pneumonia ( VAP),days of antibiotic exposure,6-month rate of acute exacerbation and 6-month mortality were measured.Results Compared with sequential MV group by PIC window,sequential MV group by PTC window had shorter duration of invasive MV[(3.8 ± 1.4),(6.5 ± 1.8) d,P =0.000 ],fewer days in ICU[(6.9 ±1.7),( 9.6 ± 1.9) d,P =0.000 ],and fewer days of antibiotic exposure.The 6-month rate of acute exacerbation and 6-month mortality were not significantly different compared to the control group[( 21.7％,22.7％,P =1.000) ; (17.4％,13.6,P=0.450) ].Conclusion Early extubation followed by non-invasive MV initiated at the point of PTC window may decrease the duration of invasive MV and reduce antibiotic prescription.%目的 探讨以降钙素原(PCT)窗为切换点实施序贯通气策略在慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭治疗中的作用.方法 将25例AECOPD合并呼吸衰竭的患者在出现完全随机分为2组,肺部感染控制窗( PIC)序贯通气组22例,PCT序贯通气23例分别在出现PIC窗或PCT窗后内由有创机械通气改为无创机械通气.比较2组患者有创机械通气时间、呼吸机相关性肺炎(VAP)发生率、抗菌药物应用时间、6个月内急性加重率、6个月内病死率等指标.结果 PCT窗序贯通气组与PIC窗序贯通气组比较,有创通气时间明显缩短[(3.8±1.4)d比(6.5±1.8)d],住ICU时间缩短[(6.9±1.7)d比(9.6±1.9)d],抗菌药物应用时间缩短[(6.0士1.9)d比(10.4±2.8)d],而6个月急性加重发生率、6个月病死率均无明显差异[21.7％ (5/23)比22.7％(5/22)；17.4％(3/23)比13.6％(2/22),P=0.450].结论 以PCT窗为切换点的序贯通气治疗能够明显缩短有创通气的时间,减少抗生素的应用,而对AECOPD合并呼吸衰竭患者的预后无不良影响.