无创正压通气序贯治疗不同治疗切换点选取方法对慢性阻塞性肺疾病急性加重期患者治疗效果的影响

摘要

Objective To observe the effect of non-invasive positive pressure ventilation ( NIPPV) in different treat-ment methods of switching points in patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD ) . Methods During August 2014 and June 2012, 128 patients with AECOPD undergoing NIPPV according to different methods of treatment were divided to the spontaneous breathing trial group (SBT group, n=64) and pulmonary infection control group (PIC group, n=64). The treatment situation and NIPPV correlation index of the two groups were observed and compared. Results The success rate of SBT group was 89. 06%, significantly higher than that of PIC group (60. 94%), and the differ-ence was statistically significant (P<0. 05). 4. 69% of SBT group underwent re-intubation, 28. 13% of PIC group underwent re-intubation, the intubation rates of the two groups were also statistically different (P<0. 05). The time of invasive mechani-cal ventilation in the SBT group was significantly longer than that in the PIC group, and the difference was statistically signifi-cant (P<0. 05). There was no significant difference between the two groups in ICU stay and in the incidence of ventilator as-sociated pneumonia (VAP) (P>0. 05). Conclusion SBT as a treatment method for NIPPV is helpful for AECOPD pa-tients in reducing the rate of re-intubation and the pain of the patients.%目的：观察无创正压通气( non-invasive positive pressure ventilation, NIPPV)序贯治疗不同治疗切换点选取方法对慢性阻塞性肺疾病急性加重期( acute exacerbation chronic obstructive pulmonary disease, AECOPD)患者治疗效果的影响。方法我院2012年6月—2014年8月收治128例AECOPD,根据行NIPPV序贯治疗治疗切换点选取方法不同将其分为自主呼吸试验( spontaneous breathing trial, SBT)组和肺部感染控制窗( pulmonary infection control, PIC)组各64例,观察比较两组治疗情况及NIPPV相关指标。结果 SBT组89.06%成功脱机明显高于PIC组60.94%成功脱机,差异有统计学意义(P<0．05)。 SBT组4.69%进行再插管,PIC组28.13%进行再插管,两组再插管率比较差异亦有统计学意义(P<0．05)。 SBT组有创机械通气时间明显长于PIC组,差异具有统计学意义(P<0.05)；两组ICU住院时间和呼吸机相关性肺炎发生率比较差异无统计学意义(P>0.05)。结论将SBT作为NIPPV序贯治疗切换点的选取方法,有助于AECOPD患者成功脱机,降低再插管率,减轻患者痛苦。