序贯机械通气治疗慢性阻塞性肺疾病呼吸衰竭的切换时机探讨  

Timing for sequential noninvasive following invasive mechanical ventilation in COPD patients with respiratory failure

作　　者：龙胜泽[1] 秦志强[1] 黄国兰[1] 郭永忠[1] 韦彩周[1] 王武[1] 陆爱玲[1] 黄桂香[1] 

机构地区：[1]广西壮族自治区人民医院呼吸内科,南宁530021

出　　处：《重庆医学》2008年第24期2820-2823,共4页Chongqing medicine

摘　　要：目的探讨有创-无创序贯性机械通气治疗慢性阻塞性肺疾病(COPD)呼吸衰竭的切换时机。方法以49例COPD并呼吸衰竭机械通气患者为研究对象。经抗感染及综合治疗,呼吸泵衰竭改善后,随机分为有创-无创序贯治疗组(序贯组)和常规治疗组(对照组)。序贯组立即拔除气管插管,应用无创正压通气(NPPV)支持脱机;对照组以常规有创机械通气方式脱机。比较两组有创机械通气时间、住ICU时间、呼吸机相关性肺炎(VAP)发生率、再插管率和病死率。结果序贯组24例,对照组25例,序贯组与对照组的有创机械通气时间为(2.8±0.9)d和(20.5±6.5)d,住ICU的时间为(3.3±0.8)d和(22.3±8.5)d,VAP发生率为16.67%(4/24)和44.00%(11/25),两组比较差异均有统计学意义(P<0.01或P<0.05)。而两组再插管率为20.83%(5/24)和16.00%(4/25),病死率为12.50%(3/24)和28.00%(7/25),两组比较差异无统计学意义(P均>0.05)。结论对COPD呼吸衰竭需机械通气患者,以呼吸泵衰竭改善为切换时机,有创-无创序贯性机械通气治疗是安全可行的,可以缩短有创机械通气时间及住ICU的时间,降低VAP发生率。Objective To discuss the optimal timing for sequential noninvasive following invasive mechanical ventilation in chro- nic obstructive pulmonary disease （COPD） patients with severe hypercapnic respiratory failure. Methods Forty-nine invasive me chanical ventilation（MV） COPD patients with severe hypercapnic respiratory failure were involved in the study. When the respira tory pump failurc（RPF1） was improved by the antibiotic and comprehensive therapy, all cases were random ized into noninvasive positive pressure ventilation （NPPV） group and control group. The early extubation was conducted and followed by noninvasive mechanical ventilation via facial mask immediately in the NPPV group. Conventional invasive mechanical ventilation was used as the weaning technique in the control group. The incidence of VAP,incidence of reintubation and mortality, the duration of invasive me chanical ventilation and days in ICU,were analyzed and compared. Results There were 24 cases in the NPPV group and 25 cases in the control group. In the N1V group,the duration of invasive mechanical ventilation was （2.8±0.9）d,while the duration was （20. 5±6.5）d in the control group （P〈0.01）. The durations of ICU stay was shorter than that in the control group. The incidence of VAP was 16.67%（4/24） in the NPPV group,44.00%（11/25） in the control group respectively （P〈0.05）. The hospital mortality was 12.50% （3/24） in the NPPV group,and 28.00%（7/25） in the control group （P〉0.05）. The incidence of reintubation was 20. 83% （5/24） in the NPPV group,16.00% （4/25） in the control group respectively （P〉0.05）. Conclusion In those COPD patients with severe respiratory failure due to RFP requiring invasive MV, sequential noninvasive following invasive MV at the appearance of RPF improved might significantly have shorter duration of invasive MV and fewer days in ICU stay,and decrease the occurrence of VIP.

关 键 词：慢性阻塞性肺疾病 机械通气 呼吸泵衰竭 

分 类 号：R563.9[医药卫生—呼吸系统] R563.8[医药卫生—内科学]