无创通气序贯治疗用于慢性阻塞性肺病患者撤离有创机械通气的价值  

Evaluation of Noninvasive Positive Pressure Ventilation in Weaning of Invasive Positive Pressure Ventilation for Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

作　　者：饶世明[1] 柳耀康 宋志芳[3] 

机构地区：[1]温州医学院,浙江温州325035 [2]上海市黄浦区中心医院呼吸内科,上海200002 [3]上海交通大学医学院附属新华医院急救中心,上海200092

出　　处：《中国临床医学》2009年第3期365-368,共4页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨无创通气(NIPPV)序贯治疗在慢性阻塞性肺部疾病急性加重(AECOPD)有创机械通气(IPPV)撤离成败中价值。方法:前瞻性收集接受IPPV>48h(经口、鼻插管)AECOPD患者,自主呼吸试验(SBTs)1次(120min)后拔管NIPPV序贯,与回顾性资料比较患者一般情况、再插管率、呼吸机相关性肺炎(VAP)发生率、病死率。结果:前瞻组15例、回顾组16例,两组年龄、APACHEⅡ评分、IPPV治疗时间(d)、SBTs开始时平均动脉压(MAP)、心率(HR)、呼吸频率(RR)无显著差异(P>0.05),前瞻组拔管成功率(93.3%,14/15例)高于回顾组(75.0%,12/16例、P<0.05)。SBTs总时间、ICU停留时间明显短于回顾组(P<0.01),VAP发生率、再插管率、病死率明显低于回顾组(P<0.05)。结论:NIPPV序贯治疗能提高AECOPD患者撤离IPPV成功率,SBTs不宜>120min/次。Objective：To evaluate the noninvasive positive ventilation （NIPPV）in weaning of invasive positive ventilation （IPPV） for patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods：The clinical data of patients with AECOPD receiving invasive positive ventilation （IPPV）〉48 hours （orointubation or nasointubation） in Huangpu Central Hospital in Shanghai were collected prospectively （prospective group） during December 1 of 2007 to March 10 of 2008.They were extubated to receiving NIPPV after spontaneous breathing trials （SBTs） for 120min only one time as their conditions became stable, while the clinical data from another group of patients with AECOPD in same Department during July 1 of 2006 to November 30 of 2007 were collected. They received SBTs for 30-120min twice a day as their condition became stable and the SBTs was prolonged day by day until lasted for 24 hours. As their condition became stable they were extubated with no NIPPV sequentially. The age, APACHE Ⅱ score, the duration of IPPV（d）,mean artery pressure （mmHg）,hear rate （HR）,respiratory rate （RR）, arterial blood gas analysis, the duration of intubation and stay in ICU, reintubation rates, extubation successful rates, morbidity of ventilation associated pneumonia （VAP）and mortality for patients of both groups were compared respectively. Results~ There were 15 cases in prospective group with 8/7 cases of male/female, 82 ± 4.93 years old of age and 24.9 ± 3.3 of APACHE Ⅱ scores. There were 16 cases in retrospective group with 10/6 cases of male/female, 79.56 ± 8.39 years old of age and 26.69 ± 3.94 of APACHE Ⅱ scores. There were no significant difference between two groups for their age and APACHE Ⅱ scores（P〉0.05）. The same as duration of IPPV（d） ,mean artery pressure （mmHg）, HR, RR, arterial blood gas analysis when SBTs of intubation and stay in of intubation and stay in VAP, reintubation rates beginning with. But there were significant differen

关 键 词：慢性阻塞性肺疾病急性加重 无创正压机械通气 有创正压机械通气 自主呼吸试验 呼吸机相关性肺炎 病死率 

分 类 号：R459.9[医药卫生—治疗学]