慢阻肺急性加重患者行有创-无创序贯机械通气切换时机的研究  

Research of switching point for sequential invasive to noninvasive ventilation in the treatment of AECOPD

作　　者：丁俊华[1] 沈雁波[1] 王霆[1] 刘春[1] 

机构地区：[1]南通大学附属医院急诊内科,江苏南通226001

出　　处：《临床肺科杂志》2015年第12期2223-2226,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨以肺部感染控制窗(PIC)联合自主呼吸试验(SBT)在慢阻肺急性加重(AECOPD)患者行序贯通气有创-无创切换治疗中的有效性和安全性。方法将91例需行有创-无创序贯机械通气的AECOPD患者根据切换点的选择分为PIC+SBT组44例和PIC组47例,比较两组VAP发生率、气管插管保留时间、机械通气总时间、ICU住院时间、再次插管率以及死亡率。结果 PIC+SBT组的ICU住院时间以及机械通气总时间小于PIC组且差异显著(P=0.020,<0.001),PIC+SBT组的再次插管率为9.1%远远小于PIC组组的27.6%,差异同样显著(P=0.023),但两组患者VAP发生率和死亡率差异并不显著(P>0.05)。结论 PIC窗联合SBT在AECODP患者序贯通气有创-无创切换可降低再次插管率、机械通气总时间以及ICU住院时间,具有重要临床意义。Objective To evaluate the feasibility and the efficacy of early extubation and sequential noninvasive mechanical ventilation （MV） switched by pulmonary infection control window （PIC window） and spontaneous breathing trials in patients with AECOPD. Methods 91 AECOPD patients treated by sequential noninvasive mechanical ventilation were divided into the PIC ＋ SBT group （44 eases ） and the PIC group （47 eases） by switching point. The rate of ventilator-associated pneumonia （VAP） , invasive MV duration, days in ICU, re-intubated rate and mortality were measured in the two groups. Results Compared with the PIC group, the PIC ＋ SBT group had shorter duration of invasive MV fewer days in ICU and lower re-intubated rate and mortality. Conclusion Early extubation followed by noninvasive MV initiated at the point of PIC window and SBT can decrease the duration of invasive MV, reduce the re-intubated rate and mortality and improve the prognosis.

关 键 词：慢性阻塞性肺疾病急性加重期 序贯机械通气 肺部感染控制窗 自主呼吸试验 

分 类 号：R563.9[医药卫生—呼吸系统]