以气胸拔管窗为切换点行有创-无创序贯机械通气治疗慢性阻塞性肺疾病急性加重合并呼吸衰竭伴发气胸患者30例疗效观察  

Application of pneumatic extubation window as switching point for invasive-noninvasive mechanical ventilation in treatment of respiratory failure in chronic obstructive pulmonary disease with pneumothorax

作　　者：陈玉梅[1] 童瑾[1] CHEN Yu-mei;TONG Jin.(Department of Respiratory Medicine, the Second Affiliated Hospital of Chongcting Medical University, Chongqing 400010, China)

机构地区：[1]重庆医科大学附属第二医院呼吸内科,重庆400010

出　　处：《中国实用内科杂志》2018年第7期615-617,共3页Chinese Journal of Practical Internal Medicine

基　　金：国家青年科学基金项目(81400004)

摘　　要：目的探讨以气胸拔管窗为切换点,指导慢性阻塞性肺疾病合并呼吸衰竭伴发气胸患者早期拔管改换无创通气的可行性,并评价其疗效。方法收集2015年9月至2017年6月重庆医科大学附属第二医院呼吸内科有创通气治疗慢性阻塞性肺疾病合并气胸病例30例,其中12例以气胸拔管窗拔管为试验组,18例通过自主呼吸试验(SBT)拔管为对照组;比较两组有创通气时间、总通气时间、住RICU时间、总住院时间、总住院费用、气胸治疗时间、呼吸机相关肺炎(VAP)、气胸加重率、拔管成功率、再插管率、出RICU率、好转出院率及28 d病死率。结果除拔管成功率和再插管率两组差异无统计学意义,其余指标试验组均优于对照组。结论对慢性阻塞性肺疾病合并呼吸衰竭伴发气胸患者,以气胸拔管窗为序贯通气的切换点,可显著改善疗效。Objective To evaluate the feasibility and the efficacy of early extubation and the sequential non-invasive mechanical ventilation （MV） in respiratory failure of AECOPD with pneumothorax at the switching point of pneumatic extubation window. Methods Totally 30 cases of intubated COPD with pneumothorax treated with MV were involved in the study. The 12 patients whose endotracheal tube was extubatednat the switching point of pneumatic extubation window were included as experiment group, while the others whose endotracheal tube was extubated in an empirical （Spontaneous breathing trail, SBT） were included as control group. ＂i-he duration of invasive MV, the duration of MV,, the length of stay in respiratory intensive care unit （RICU）, total hospital sta）5 hospitalization expense, pneumothorax treatment time, the incidence of ventilator associated pneumonia, pneumothorax increase rate, the extubation success rate, re-intubation rate, out of RICU rate, discharge rate and hospital mortality rate in 28 days were observed and compared between two groups. Results All clinical parameters of the experiment group were better than the control group, the duration of MV, hospitalization expense, out of RICU rate, and hospital mortality rate in 28 days, P〈0.05, other parameters, P〈0.01. However, the extubation success rate and re-intubation rate, P〉0.05. Conclusion The application of pneumatic extubation window as the switching point for early extubation and noninvasive ventilation can significantly improve the therapeutic effect in patients with severe respiratory failure in COPD with pneumothorax.

关 键 词：气胸拔管窗 机械通气 慢性阻塞性肺疾病 呼吸衰竭 气胸 

分 类 号：R56[医药卫生—呼吸系统]