慢性阻塞性肺疾病急性呼吸衰竭患者从有创过渡到无创机械通气的时机探讨  

Time for extubation and sequential noninvasive mechanical ventilation in COPD patients with exacerbated respiratory failure who received invasive ventilation

作　　者：陈杰[1] 邱东华[1] 陶德莹 崔恩海[1] 

机构地区：[1]浙江大学医学院教学医院,湖州市中心医院呼吸内科,湖州313000

出　　处：《中华结核和呼吸杂志》2001年第2期99-100,共2页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的　探讨慢性阻塞性肺疾病 (COPD)急性呼吸衰竭从有创过渡到无创机械通气的适宜时机。方法　 2 4例COPD急性呼吸衰竭患者有创机械通气 3天后随机分成两组 ,每组 12例。A组予拔除气管导管改面罩机械通气 ,B组继续有创机械通气。观察两组呼吸机相关性肺炎 (VAP)例数、死亡例数、机械通气时间、住院时间。结果　A、B两组发生VAP的例数分别为 0和 7例 (P =0 0 2 7) ;死亡例数为 0和 3例 (P =0 2 17) ;有创机械通气 3天后尚需机械通气时间为 (7± 5 )天和 (15± 12 )天(P <0 0 5 ) ;住院时间为 (16± 6 )天和 (2 5± 12 )天 (P <0 0 5 )。结论　COPD急性呼吸衰竭有创机械通气 3天后拔除气管导管改面罩机械通气能降低VAP发生率 ,缩短机械通气时间和住院时间。Objective To discuss the optimal time for extubation and sequential non invasive mechanical ventilation in COPD patients with exacerbated respiratory failure who received invasive ventilation. Methods 24 patients received invasive ventilation for 3 days were randomly assigned to receive noninvasive ventilation (study group) or to continue the weaning process with invasive ventilation (control group) The incidence of ventilator associated pneumonia(VAP), the incidence of death, the duration of ventilation, the hospitalization were analyzed in two groups. Results Between study group and control group, the incidence of VAP was 0/12 vs 7/12, P =0 027; the incidence of death was 0/12 vs 3/12, P =0 217; the continued duration of ventilation after invasive ventilation for 3 days was (7±5) days vs (15±12) days, P <0 05; the hospitalization was (16±6) days vs (25±12) days, P <0 05, respectively. Conclusions In COPD patients with exacerbated respiratory failure who received invasive ventilation, invasive ventilation for 3 days followed by noninvasive ventilation may decrease the incidence of VAP, shorten the duration of ventilation and hospitalization

关 键 词：慢性阻塞性肺疾病 急性呼吸衰竭 机械通气 治疗 

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