序贯性机械通气治疗COPD所致严重呼吸衰竭治疗切换点时间窗的研究  

Timeframe for sequential non-invasive following short-term invasive mechanical ventilation in COPD induced hypercapnic respiratory failure

作　　者：郑大伟[1] 王承志[1] 刘仁水[2] 高峰[1] 邓顺莲 周鹏[1] 何炎[1] 

机构地区：[1]怀化市第二人民医院重症监护室,湖南怀化418000 [2]怀化市第二人民医院呼吸科,湖南怀化418000

出　　处：《临床肺科杂志》2011年第3期360-362,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的探索早期拔管改换无创机械通气策略的技术可行性并评价其治疗效果。方法选择接受气管插管和机械通气的慢性阻塞性肺疾病(COPD)病例36例,随机分为治疗组20例和对照组16例,治疗组20例以同步间歇强制通气十压力支持通气(SIMV+PSV)方式行机械通气,待"改良GCS评分达15分标准"稳定2h窗口期出现,此时拔除气管导管,改用经鼻面罩压力支持通气十呼气末正压(PSV+PEEP)通气,以后渐减PSV水平直至脱离呼吸机。对照组16例待肺部感染明显控制时判为"肺部感染控制窗"出现,此时拔除气管导管,改无创通气直至脱离呼吸机。动态观察两组病例机械通气前通气及氧合指标,两组接受有创机械通气时间、总机械通气时间、总住院时间、重新插管率、VAP发生例数。结果治疗组与对照组的治疗前各指标相仿(P>0.05);两组有创通气时间分别为(3.2±1.1)和(5.4±2.3)d,P<0.05;呼吸机相关肺炎发生例数分别为0和3例,P<0.05;住院时间分别为(17士3)和(21士5)d,P<0.05。结论对COPD合并呼吸衰竭插管上机病例,以"改良GCS评分达15分标准"窗口期为时机,早期拔管改用经鼻面罩无创通气可以显著改善治疗效果。Objective To estimate the feasibility and the efficacy of early extubation and the improved sequential non-invasive mechanical ventilation（MV）in COPD with exacerbated hypercapnic respiratory failure.Methods Choose 36 cases to accept endotracheal intubation and mechanical ventilation in chronic obstructive pulmonary disease（COPD）,which were randomly divided into treatment group 20 cases and control group 16 cases.Treatment group,20 patients with synchronous intermittent mandatory ventilation ＋ pressure support ventilation（SIMV＋PSV）mode mechanical ventilation.To be＂improved GCS score of 15 points standard＂window period appears at this time extubation,use of nasal mask pressure support＋PEEP ventilation（PSV＋PEEP）ventilation,after the PSV level has been decreasing to a level beyond breathing machine.Control group,16 cases of pulmonary infection to be significant control of the sub as＂pulmonary infection control window＂appears,this time extubation,changing from the non-invasive ventilation until breathing machine.Dynamic observation of two cases of mechanical ventilation before the ventilation and oxygenation index,two groups received invasive mechanical ventilation time,total mechanical ventilation time,total hospital stay,re-intubation rate,VAP occurred in the number of cases.Results The results of the treatment group and control group before treatment is similar to each index（P0.05）;two invasive ventilation time was（3.2±1.1）and（5.4±2.3）d,P0.05;cases of ventilator-associated pneumonia in the number of 0 and 3 cases,respectively,P0.05;hospital stay were（17±3）and（21±5）d,P0.05.Conclusion COPD with respiratory failure after intubation cases on the breathing machine in order to＂improve the standard GCS score of 15 points＂window period is the timing of early extubation,use of non-invasive nasal mask ventilation can significantly improve the therapeutic effect.

关 键 词：肺疾病 阻塞性 呼吸衰竭 机械通气 改良GCS评分标准 

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