有创与无创序贯机械通气抢救非慢性阻塞性肺病所致重症呼吸衰竭  

Application of Sequential Invasive to Noninvasive Mechanical Ventilation in Treatment of Severe Respiratory Failure due to Non-COPD

作　　者：周颖[1] 余荣环[1] 胡强[1] 黄运平[1] 陈弘群[1] 胡斌[1] 黄莺[1] 杨海华[1] 

机构地区：[1]上海市徐汇区中心医院呼吸科,上海200031

出　　处：《中国临床医学》2011年第2期167-169,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨有创与无创序贯机械通气(简称序贯性机械通气)抢救非慢性阻塞性肺病(COPD)所致严重呼吸衰竭的临床效果及应用价值。方法:选择2006年1月—2008年12月非COPD所致呼吸衰竭25例为序贯通气组,有创通气后予脱机拔除气管插管序贯无创机械通气治疗,选择2003年1月—2005年12月间同样病情病例24例作为常规通气组,采用有创通气直至撤机拔管。观察2组病例的血气分析指标、机械通气时间、呼吸机相关性肺炎(VAP)发生例数、撤机成功例数、住院死亡例数、住院费用等。结果:序贯通气组和常规通气组治疗前基础情况匹配良好(P>0.05)。2组患者在治疗后病情均能显著改善(P>0.05),与常规通气组比较,序贯通气组有创通气时间显著缩短[(5.58±2.55)d比(16.67±4.99)d,P<0.001]、VAP发生例数显著减少(3例比10例,P=0.025)、死亡例数显著减少(4例比12例,P=0.016)、住院总费用显著降低[(26 281±10 672)元比(32 446±9 435)元,P=0.038]。结论:序贯性机械通气抢救非COPD所致呼吸衰竭也能明显改善血流动力学指标,减少有创机械通气的并发症。Objective：To evaluate the efficacy of early intubation and sequential invasive to noninvasive mechanical ventilation（MV） in treatment of severe respiratory failure due to non-COPD.Methods： From January 2006 to November 2008,25 patients with severe respiratory failure due to non-COPD were involved in the sequential therapy group were treated sequential in-noninvasive mechanical ventilation.The other 24 cases from January 2003 to November 2005 with similar clinic characteristics who continuously received invasive MV were assigned to control group.Compare the markers of blood gas analysis,the duration of MV,the incidence of ventilator-associated pneumonia,the incidence of death.Results：There were no significant differences in the clinical characteristics between the two groups（P〈0.05）.The patients in the sequential therapy group showed less invasive MV duration[（5.58±2.55） vs.（16.67±4.99）d,P〈0.001],lower incidence of ventilation associate pneumonia（3/25 vs.10/24,P=0.025）,lower mortality rate（4/25 vs.12/24,P=0.016）and,fewer hospitalization cost [（26 281±10 672） vs.（32 446±9 435）Yuan,P=0.038].Conclusions： Sequential invasive to noninvasive MV strategy is effective treatment for severe respiratory failure of non-COPD,it could cause significant improvement in hemodynamic and reduced the complications of invasive mechanical ventilation.

关 键 词：呼吸衰竭 机械通气 无创正压通气 慢性阻塞性肺疾病 

分 类 号：R563.8[医药卫生—呼吸系统]