目的 比较不同有创-无创序贯通气切换时机对慢性阻塞性肺疾病(COPD)伴呼吸衰竭患者的影响.方法 选取2014年10月-2016年10月在复旦大学附属中心医院青浦分院行机械通气治疗的COPD伴呼吸衰竭患者84例,根据机械通气方式分为A组(n=34)、B组(n=25)、C组(n=25).A组患者行有创机械通气治疗并常规撤机拔管;B组患者行有创-无创序贯通气治疗,以出现肺部感染控制窗(PIC窗)为序贯通气切换时机;C组患者行有创-无创序贯通气治疗,以格拉斯哥昏迷量表(GCS)评分≥9分且维持2h作为序贯通气切换时机,两组患者撤机标准相同.比较3组患者机械通气治疗前和撤机时心率、平均动脉压(MAP)、动脉血气分析指标及治疗情况、撤机成功率、病死率、治疗期间并发症发生率.结果 3组患者机械通气治疗前和撤机时心率、MAP、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、pH值比较,差异无统计学意义(P＞0.05).B、C组患者有创机械通气时间、总机械通气时间、ICU入住时间短于A组,住院费用少于A组(P＜0.05);B组和C组患者有创机械通气时间、ICU入住时间比较,差异无统计学意义(P＞0.05),而C组患者总机械通气时间少于B组,住院费用少于B组(P＜0.05).3组患者撤机成功率和病死率比较,差异无统计学意义(P＞0.05).B、C组患者治疗期间并发症发生率低于A组(P＜0.05);B组和C组患者治疗期间并发症发生率比较,差异无统计学意义(P＞0.05).结论 以PIC窗作为序贯通气切换时机和以GCS评分≥9分且持续2h作为有创-无创序贯通气切换时机治疗COPD伴呼吸衰竭患者的撤机成功率、病死率及安全性相似,但后者可更有效地缩短患者总机械通气时间并减少住院费用.%Objective To compare the impact of different invasive and non-invasive sequential ventilation switching time on chronic obstructive pulmonary disease patients complicated with and respiratory failure.Methods A total of 84 chronic obstructive pulmonary disease patients complicated with and respiratory failure were selected in the Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University from October 2014 to October 2016,all of them received mechanical ventilation and they were divided into A group (n =34),B group (n =25) and C group (n =25) according to mechanical ventilation methods.Patients of A group received invasive mechanical ventilation and conventional ventilator weaning and extubation,patients of B group received invasive and non-invasive sequential mechanical ventilation and take Pulmonary Infection Control Window as the switching time,patients of C group received invasive and non-invasive sequential mechanical ventilation and take GCS score equal or over 9 keeping for 2 hours as the switching time,ventilator weaning standard in B group and C group was same.Heart rate,MAP and arterial blood-gas analysis results before mechanical ventilation and at ventilator weaning,therapeutic conditions,ventilator weaning success rate,fatality rate and incidence of complications during the treatment were compared among the three groups.Results No statistically significant differences of heart rate,MAP,PaO2,PaCO2 or pH was found among the three groups before mechanical ventilation or at ventilator weaning (P ＞ 0.05).Duration of invasive mechanical ventilation,total duration of mechanical ventilation and ICU stays in B group and C group were statistically significantly shorter than those in A group,hospital fees in B group and C group was statistically significantly less than that in A group,respectively (P ＜ 0.05);no statistically significant differences of duration of invasive mechanical ventilation or ICU stays was found between B group and C group (P ＞ 0.05),total duration of mechanical ventilation in C group was statistically significantly shorter than that in B group,meanwhile hospital fees in C group was statistically significantly less than that in B group (P ＜ 0.05).No statistically significant differences of ventilator weaning success rate or fatality rate was found among the three groups (P ＞ 0.05).During the treatment,incidence of complications in B group and C group was statistically significantly lower than that in A group,respectively (P ＜ 0.05),while no statistically significant differences of incidence of complications was found between B group and C group (P ＞ 0.05).Conclusion In the invasive and non-invasive sequential mechanical ventilation in treating chronic obstructive pulmonary disease patients complicated with and respiratory failure,taking Pulmonary Infection Control Window as the switching time has similar ventilator weaning success rate,fatality rate and safety with taking GCS score equal or over 9 keeping for 2 hours as the switching time,but the latter can more effectively shorten the total duration of mechanical ventilation and cut down the hospital fees.
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