序贯通气在部分慢性阻塞性肺疾病所致呼吸衰竭中的应用  

Sequential mechanical ventilation in some patients of chronic obstructive pulmonary disease with respiratory failure

作　　者：辛绍斌[1] 魏海苓[1] 

机构地区：[1]天津市人民医院重症医学科,300121

出　　处：《中国医药》2011年第10期1176-1177,共2页China Medicine

摘　　要：目的探讨慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭，无创正压机械通气（NIPPV）有效但不能长时间耐受时，呼吸机治疗方式的选择。方法将43例无创正压机械通气（NIPPV）有效但不能长时间耐受的COPD合并Ⅱ型呼吸衰竭患者随机分为传统机械通气组（对照组，25例）和序贯机械通气组（研究组，18例）。对照组患者继续给予NIPPV，无效后再改为有创机械通气（IPPV）；研究组患者给予IPPV，根据病情早期脱机，序贯以NIPPV。比较2组患者最终的病死率、平均住院时间和平均住院费用。结果对照组21例好转出院，4例死亡，病死率为16．0％；平均住院时间（16．6±4．9）d，平均住院费用（50766±21082）元。研究组17例好转出院，1例死亡，病死率为5．5％；平均住院时间（13．7±5．1）d，平均花费（78576±25540）元。2组比较，研究组病死率低于对照组，平均住院费用高于对照组，平均住院时间少于对照组，差异均有统计学意义（P〈0．05）。结论对于COPD合并Ⅱ型呼吸衰竭，NIPPV有效但不能长时间耐受的患者，序贯机械通气治疗病死率和住院时间明显低于传统机械通气治疗，但住院费用更高。Objective To investigate the respiratory therapy when noninvasive positive pressure ventilation （NIPPV） is effective but intolerant in chronic obstructive pulmonary disease（COPD） with type II respiratory failure. Methods Forty-three COPD patients with respiratory failure, to whom NIPPV was effective but intolerant, were divided randomly into control （n = 25 ） and treatment group （n = 18 ）. The control group patients were treated sequentially by NIPPV. The treatment was replaced by invasive positive pressure ventilation （IPPV） when NIPPV was ineffective. The treatment group patients were treated by IPPV. Based on patients condition, IPPV was early weaned and patients were treated sequentially by NIPPV. Mortality, the average hospital cost and the average hospi- tal days were compared after the treatment. Results In the 25 cases of the control group, 21 cases recovered and 4 cases died. The mortality was 16.0%. The average hospital cost was 50 766 ＋ 21 082 CNY and the average hospital days were （16.6 ± 4.9）d. In the 18 cases of the treatment group, 17 cases recovered and 1 case died. The mortality is 5.5%. The average hospital cost was 78 576 -25 540 CNY and the average hospital days were （13.7 ±5.1 ）d. The mortality of the treatment group was lower than that of the control group ; the average hospital days of the treatment group was lower than those of the control group; the average hospital cost of the treatment group was higher than that of the control group. Conclusions When NIPPV is effective but intolerant to COPD with type Ⅱ respiratory failure, the mortality of the sequential mechanical ventilation is lower than that of the conventional mechanical ventilation. Sequential mechanical ventilation has less hospital days but more hospital cost.

关 键 词：肺疾病 慢性阻塞性 序贯机械通气 呼吸衰竭 

分 类 号：R563[医药卫生—呼吸系统]