目的 评估以无创通气适应证为切换点的序贯治疗对慢性阻塞性肺疾病急性加重期(AECOPD)患者临床效果.方法 监测2017年1月至12月慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭入住ICU、EICU接受有创通气的89例患者.以2017年7月1日为时间节点,按时间先后分为感染控制窗组43例(2017年1月1日至2017年6月31日)与无创适应证组46例(2017年7月1日至2017年12月31日).感染控制窗组以出现"PIC"作为有创－无创序贯通气治疗的切换点,后行无创治疗方案.无创适应证组的患者在有创机械通气早期尚未出现肺部感染控制窗(PIC),但原发感染得到有效控制且符合无创通气治疗适应证,作为有创-无创序贯治疗的切换点,后行无创治疗方案.比较两组患者机械通气时长、VAP发生率、再插管率、ICU留置时间及均次住院费用.结果 无创通气适应证组机械通气时长、VAP发生率、再插管率、ICU留置时间及均次住院费用均少于感染控制窗组,差异有统计学意义(P<0.05).结论 无创通气适应证作为有创－无创序贯通气治疗的"切换点",对改善临床AECOPD患者治疗质量,减少医疗资源的浪费,减少疾病负担具有一定的意义,值得临床推广.%Objective To evaluate the clinical effect of sequential therapy with noninvasive ventilation adaptation as a switching point for AECOPD patients. Method A controlled trial was conducted to monitor 89 patients with chronic obstructive pulmonary disease combined with type II respiratory failure admitted to our hospital from January 2017 to December 2017,who received invasive ventilation in ICU and EICU.July 1,2017, the time node was divided into infection control window group in 43 cases(January 1st,2017 -June 31st,2017)and non-invasive indication group in 46 cases(July 1st,2017-December 31st,2017). The infection control window group had "PIC" as the switching point of invasive and noninvasive sequential ventilation treatment,followed by noninvasive treatment. In the early stage of invasive mechanical ventilation,there was no pulmonary infection control window(PIC)in patients with noninvasive indications. It accorded with the indication of non-invasive ventilation treatment. As a switch point of invasive non-invasive sequential therapy,a non-invasive treatment plan was implemented. The two groups of patients were compared with the length of mechanical ventilation,the incidence of VAP,the rate of re intubation,the time of ICU indwelling and the cost of all hospitalization. Result The duration of mechanical ventilation,the incidence of VAP,the rate of re intubation,the time of ICU indwelling and the cost of hospitalization were all less than those in the infection control window group. The difference was statistically significant(P<0.05). Conclusion As a switch point of invasive non-invasive sequential ventilation,non-invasive ventilation indication has a certain significance for improving the quality of clinical AECOPD patients,reducing the waste of medical resources and reducing the burden of disease. It is worthy of clinical promotion.
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