有创-无创序贯通气治疗慢性阻塞性肺疾病并急性呼吸衰竭的临床效果及其切换点研究

摘要

Objective To investigate the clinical effect of sequential invasive and non-invasive ventilation on COPD complicated with acute respiratory failure and its switching point. Methods From December 2012 to December 2014,a total of 60 COPD patients complicated with acute respiratory failure were selected in Department of Respiratory Medicine and ICU, Lecong Hospital of Shunde District,Foshan,and they were randomly divided into treatment group and control group,each of 30 cases. Patients of control group were given invasive ventilation till ventilator weaning,while patients of treatment group were given sequential invasive and non - invasive ventilation till ventilator weaning, taking pulmonary - infection - control - window ( PICW) as the switching point. PICW,incidence of ventilator-associated pneumonia and aerothorax,treatment time including invasive ventilation time,total mechanical ventilation time and ICU stays,success rate of ventilator weaning,reintubation rate, success rate of rescue,fatality rate were compared between the two groups. Results No statistically significant differences of PICW or incidence of aerothorax was found between the two groups ( P ﹥0. 05 ), the incidence of ventilator - associated pneumonia of treatment group was statistically significantly lower than that of control group ( P ﹤0. 05 ). Invasive ventilation time,total mechanical ventilation time and ICU stays of treatment group were statistically significantly shorter than those of control group( P﹤0. 05 ). The success rate of ventilator weaning and success rate of rescue of treatment group were statistically significantly higher than those of control group,and the fatality rate of treatment group was statistically significantly lower than that of control group ( P ﹤0. 05 );while no statistically significant differences of reintubation rate was found between the two groups( P ﹥0. 05 ). Conclusion Sequential invasive and non - invasive ventilation has certain clinical effect on COPD complicated with acute respiratory failure,which can effective improve the success rate of ventilator weaning and success rate of rescue, shorten the treatment time, reduce the incidence of ventilator - associated pneumonia, and PICW may be a comparatively good switching point for invasive and non-invasive ventilation.%目的：探讨有创-无创序贯通气治疗慢性阻塞性肺疾病（ COPD）并急性呼吸衰竭的临床效果及其切换点。方法选择佛山市顺德区乐从医院2011年12月—2014年12月ICU及呼吸内科收治的COPD并急性呼吸衰竭患者60例，随机分为治疗组和对照组，各30例。对照组患者给予气管插管及机械辅助通气治疗直至拔管撤机；治疗组患者给予有创-无创序贯通气治疗，以肺部感染控制窗为切换点进行有创机械通气与无创机械通气的转换，直至撤机。记录两组患者肺部感染控制窗、并发症发生情况〔呼吸机相关性肺炎（ VAP）、气胸〕、治疗时间（有创机械通气时间、总机械通气时间、住ICU时间）、撤机成功率、再插管率、抢救成功率及病死率。结果两组患者肺部感染控制窗比较，差异无统计学意义（P﹥0.05）。治疗组患者VAP发生率低于对照组（P﹤0.05）；两组患者气胸发生率比较，差异无统计学意义（ P﹥0.05）。治疗组患者有创机械通气时间、总机械通气时间及住ICU时间均短于对照组（ P﹤0.05）。治疗组患者撤机成功率和抢救成功率高于对照组，病死率低于对照组（ P﹤0.05）；两组患者再插管率比较，差异无统计学意义（P﹥0.05）。结论有创-无创序贯通气治疗COPD并急性呼吸衰竭的临床效果确切，能有效提高撤机成功率和抢救成功率、缩短治疗时间、降低VAP发生率，且肺部感染控制窗是有创与无创机械通气治疗的较佳切换点。