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目的探讨有创与无创序贯性机械通气在慢性阻塞性肺疾病(COPD)重症呼吸衰竭患者救治中的方法与疗效。方法对36例COPD重症呼吸衰竭患者进行气管插管并施行机械通气,出现“肺部感染控制窗”后,随机分为序贯治疗组(18例)和对照组(18例)。序贯组治疗方法:出现“肺部感染控制窗”后,立即拔出气管插管,改用口鼻面罩双水平气道正压通气(BiPAP)。对照组治疗方法:“肺部感染控制窗”出现后,继续按常规有创机械通气方法治疗,以目前临床常用压力支持通气(PS)模式脱机,两组同时进行监护,观察两组患者有创通气时间、呼吸机相关肺炎(VAP)发生例数、总机械通气时间、住院时间、监护时间、撤机成功例数、住院费用和院内死亡例数。结果两组患者发生VAP的例数分别为0和8例(P<0.05),总机械通气时间为(14.2±1.3)d和(22.1±0.7)d(P<0.05);住院时间为(17.3±1.5)d和(26.8±2.4)d(P<0.01)。结论在“肺部感染控制窗”指导下的有创-无创序贯性脱机治疗方法,可以明显缩短机械通气,降低VAP发病率,缩短ICU和总住院时间,改进治疗效果,降低治疗费用,是具有一定临床实用价值的有效脱机方案。
Objective To investigate the methods and curative effects of invasive and noninvasive sequential mechanical ventilation in the treatment of patients with severe respiratory failure of chronic obstructive pulmonary disease (COPD). Methods Thirty - six patients with COPD were treated by endotracheal intubation and mechanical ventilation. After “infection control window” appeared, they were randomly divided into sequential treatment group (18 cases) and control group (18 cases). Sequential group therapy: Immediately after “Pulmonary Infection Control Window” appears, remove the endotracheal tube and switch to bi-level positive airway pressure (BiPAP) using a nasal mask. Control group treatment: “pulmonary infection control window ” appear, continue to follow the conventional invasive mechanical ventilation treatment, the current clinical use of pressure support ventilation (PS) mode off, the two groups were monitored at the same time, the two groups were observed The duration of invasive ventilation, ventilator-associated pneumonia (VAP), total mechanical ventilation, length of stay, length of stay, number of successful weaning, number of hospitalizations, and number of nosocomial deaths were recorded. Results The incidence of VAP in both groups was 0 and 8 (P <0.05), the duration of mechanical ventilation was (14.2 ± 1.3) days and (22.1 ± 0.7) days (P <0.05) ± 1.5 d and (26.8 ± 2.4) d (P <0.01). Conclusion The invasive and noninvasive sequential offline treatment under the guidance of the control window of pulmonary infection can significantly reduce the mechanical ventilation, reduce the incidence of VAP, shorten the ICU and total hospital stay, improve the treatment effect and reduce the treatment The cost is a valid offline program with some clinical practical value.