无创正压通气在慢性阻塞性肺疾病患者机械通气撤机中的应用

摘要

目的 评价无创正压通气(NPPV)作为慢性阻塞性肺疾病急性加重(AECOPD)有创通气患者撤机方式的应用效果.方法 74例AECOPD有创通气患者随机选择NPPV(拔管后立即应用NPPV过渡撤机)或常规低水平压力支持通气方式撤机.比较两组动脉血气变化、呼吸机相关性肺炎(VAP)的发生率、机械通气时间、住院时间、再插管率和病死率.结果 两组患者总的机械通气时间、住院时间和再插管率相似.但NPPV撤机组有刨通气时间明显缩短(P＜0.01),VAP发生率和病死率均低于常规撤机组(P＜0.05).结论 NPPV用作AECOPD并呼吸衰竭患者的撤机方式,可明显缩短有创通气时间,降低VAP发生病和病死率,改善患者预后.%Objective To study the efficacy of noninvasive positive pressure ventilation(NPPV) for weaning in patients with chronic obstructive pulmonary disease( AECOPD) undergoing mechanical ventilation. Methods A total of 74 AECOPD patients undergoing mechanical ventilation was randomly divided into two groups of A(36 cases,given NPPV soon after extubation for weaning) and B(38 cases, given conventional weaning by lower level pressure support ventilation). Arterial blood gase was analyzed. The incidence of ventilator-associated pneumonia (VAP), duration of mechanical ventilation,hospital stay and outcomes were compared. Results There were no significant differences in total duration of mechanical ventilation, hospital stay and reintubation rate between two groups. However, the duration of invasive ventilation during weaning was significantly shorter in group A than that in group B(P<0. 01). The rates of VAP and mortality were markedly lower in group A than those in group B(P<0. 05). Conclusion Compared to conventional weaning technique, use of NPPV for weaning has the advantages of shorter duration of invasive ventilation and less incidence of VAP and mortality in AECOPD patients undergoing mechanical ventilation.