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目的:探索有创-无创序贯通气法对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的应用疗效。方法:选择COPDⅡ型呼吸衰竭需机械通气的患者77例,随机分为序贯组35例,常规组32例,所有患者均接受气管插管及机械通气,待肺部感染控制(PIC)窗出现后,选择无创呼吸机模式(BiPAP),常规组则保持机械通气至脱机。观察两组的主要指标并记录序贯组拔管时和BiPAP治疗4 h后的血气变化。结果:序贯组的有创通气时间为(73.58±30.17)h、气管插管复插率为5.7%和VAP发生率为2.9%,均显著低于常规组,差异有统计学意义(均P=0.000),两组总机械通气时间以及呼吸重症监护病房(RICU)住院时间的差异近似,无统计学意义(总机械通气时间:P=0.958;RICU住院时间:P=0.654)。序贯组在选择BiPAP后,pH、血氧分压(PaO2)、二氧化碳分压(PaCO2)、心率(HR)和平均动脉压(MAP)值与拔管时的差异均近似,差异无统计学意义(均P>0.05)。结论:有创-无创序贯通气可明显缩短机械通气时间,降低气管插管复插率及VAP发生率,结合有效的护理措施能够有效改善COPD合并Ⅱ型呼吸衰竭。
Objective: To explore the effect of invasive-noninvasive sequential ventilation on chronic obstructive pulmonary disease (COPD) with type Ⅱ respiratory failure. Methods: COPDⅡ respiratory failure 77 patients required mechanical ventilation, were randomly divided into 35 cases, 32 cases of conventional sequential group, all patients receiving mechanical ventilation and intubation, to be lung infection control (PIC) box will appear After the non-invasive ventilator mode (BiPAP) was selected, the conventional group remained mechanically ventilated until offline. The main indexes of the two groups were observed and the changes of blood gas in the sequential group after extubation and 4 h after BiPAP treatment were recorded. Results: The duration of invasive ventilation was (73.58 ± 30.17) h in sequential group, 5.7% in tracheal intubation and 2.9% in VAP, both of which were significantly lower than those of conventional group (P = 0.000), differences in length of hospital stay of two total duration of mechanical ventilation and respiratory intensive care unit (RICU) approximation, was not statistically significant (total duration of mechanical ventilation: P = 0.958; RICU hospital stay: P = 0.654). After selecting BiPAP, the values of pH, PaO2, PaCO2, HR and MAP in sequential group were similar to those at extubation, with no statistical difference Significance (all P> 0.05). Conclusion: Noninvasive invasive ventilation can significantly shorten the duration of mechanical ventilation and reduce the rate of tracheal intubation and VAP. Combining effective nursing measures can effectively improve COPD with type Ⅱ respiratory failure.