有创机械通气不同实施时机对慢性阻塞性肺疾病急性发作合并重度呼吸衰竭患者治疗疗效的影响研究  

Effect of Invasive Mechanical Ventilation Applied at Different Occasions on Acute Exacerbation of COPD Complicated with Severe Respiratory Failure

作　　者：孙治霞[1] 韩丽华[2] 申亚晖[1] 索红亮[2] 

机构地区：[1]河南省中医院重症医学科,河南省郑州市450002 [2]河南省中医院心病科国家中管局病毒性心肌炎益气养阴重点研究室

出　　处：《中国全科医学》2012年第7期767-768,共2页Chinese General Practice

摘　　要：目的探讨重症监护病房(ICU)对慢性阻塞性肺疾病(COPD)急性发作合并重度呼吸衰竭患者有创机械通气的选择时机。方法对62例COPD急性发作合并重度呼吸衰竭患者资料进行回顾分析,根据实施有创机械通气治疗的时间,将其分为早期机械通气组(A组)和延迟机械通气组(B组),两组均给予抗感染、解痉、平喘、祛痰、气道分泌物引流、纠正水电解质紊乱、营养支持等治疗措施,观察两组患者的血气分析相关指标及有创机械通气时间、总机械通气时间、ICU住院时间等。结果治疗后A组氧合指数(PaO2/FiO2)高于B组,而动脉血二氧化碳分压(PaCO2)低于B组,差异均有统计学意义(P<0.05)。同时,A组患者的有创机械通气时间、总机械通气时间、ICU住院时间均少于B组,差异均有统计学意义(P<0.05)。结论 COPD急性发作合并重度呼吸衰竭符合有创机械通气指征的患者早期进行气管插管,有助于改善呼吸衰竭、减少有创通气时间,减少ICU住院时间。Objective To investigate the appropriate occasion for application of invasive mechanical ventilation to treat acute exacerbation of chronic obstructive pulmonary diseases（COPD） complicated with severe respiratory failure in ICU. Methods The data of 62 patients with acute exacerbation of COPD complicated by severe respiratory failure were retrospectively analyzed.According to the time applying invasive mechanical ventilation,all the patients were divided as early mechanical ventilation group（A） and delayed mechanical ventilation group（B）.They were all given basic therapies including antibiotics,spasmolytics,anti-asthmatics,expectorants,sputum aspiration,correcting electrolyte imbalances,and nutrition supporting.The relevant indexes of arterial blood gas analyses,and the time applying invasive mechanical ventilation,total duration of mechanical ventilation,and hospitalization days in ICU of the patients in the two groups were comparatively analyzed. Results The mean of oxygenation index（PaO2/FiO2） in group A was significantly higher than that in group B,and the mean of PaCO2 was significantly lower（P0.05）.The time of invasive mechanical ventilation,total duration of mechanical ventilation and ICU hospitalization days in group A were more less than those in group B（P0.05）. Conclusion An early tracheal intubation could improve respiratory failure,reduce the durations of invasive ventilation and ICU hospitalization for a patient with acute exacerbation of COPD complicated with severe respiratory failure.

关 键 词：肺疾病 慢性阻塞性 呼吸衰竭 呼吸 人工 临床观察 

分 类 号：R562.25[医药卫生—呼吸系统]