摘要
目的研究慢性阻塞性肺疾病(COPD)急性加重有创通气早期拔管后行无创序贯通气治疗的疗效。方法将诊断为COPD急性加重需要机械通气的36例患者随机分成序贯组和对照组:序贯组18例,对照组18例。开始时均采用有创机械通气,A/C方式,然后改为SIMV+PSV方式,逐渐减少SIMV和PSV,序贯组到SIMV和PSV分别在10次/min和10cmH2O左右,在出现肺部感染控制窗时,拔管应用无创通气。而对照组则将SIMV和PSV分别减少到5次/min和5cmH2O水平时直至脱机。观察两组中ICU留住时间、机械通气时间、VAP的发生情况、撤机成功率和病死率。结果序贯组和对照组机械通气时间分别为(14±7)d和(22±15)d,(P<0.05),ICU留住时间分别为(14±7)d和(25±15)d,(P<0.05),VAP的发生分别为0、9例(P<0.05)。撤机成功例数分别为16、14例(P>0.05)。病死分别为2、4例(P>0.05)。结论对COPD急性加重的患者应用有创无创序贯治疗,能减少机械通气时间和ICU留住时间,以及VAP的发生率。
Objective To study the therapeutic effects in early stage of invasive ventilation extubation and sequential non-invasive ventilation in acute exacerbation of COPD,Methods The 36 patients subjected to mechanical ventilation were diagnosed the acute exacerbation of COPD and divided into sequential group and control group randomly： 18 patient in sequential group,18 patient in control group. In the beginning, A/C model controlled ventilation was adopted in invasive ventilation, and then SIMV＋ PSV model was taken, then,reducing SIMV and PSV gradually,until 10 times/minute and10cmH2O in sequential group, at the same time; if the pulmonary infection controlled window appeared,the early extubation was conducted and followed by non-invasive ventilation; on the other hand,in the control group, reducing SIMV and PSV until 5times/minute and 5cmH2O,and then taking extubation.The duration of ICU stay, the duration of mechanical ventilation,the incidence of ventilation-associated pneumonia, the rate of weaning success and the rate of mortality were examined.Results For sequential group and control group,the duration of ICU was （14±7）days vs （25±15）days （P〈0.05）,the total duration of mechanical ventilation was （14±7）days vs（22±15）days（P〈0.05）,the incidence of VAP were 0/18vs 9/18, and the rate of mortility were 2/18 vs 4/18 （P〉0.05）. Conclusion In the acute exacerbation of COPD requiring sequential non-invasive following invasive mechanical ventilation at the point of pulmonary infection control window may decrease the duration of ICU stay, total duration of mechanical ventilation and the risk of VAP.
出处
《实用医药杂志》
2007年第1期15-17,共3页
Practical Journal of Medicine & Pharmacy
关键词
慢性阻塞性肺疾病
机械通气
肺部感染控制窗
序贯治疗
Chronic obstructive pulmonary disease Mechanical ventilation Pulmonary infection controlled window Sequential therapy
