轻度镇静对慢性阻塞性肺疾病急性加重期患者无创正压通气预后的影响——附45例报告

• 作 者: 郭志强 李志云 王恩燕 戴坤鹏 孔继昌 徐小民 王滨 杨文珍 孟令宝 李建国
• 机 构: 中国石油华北油田公司总医院ICU,
• 出 处: 新医学
• 发表日期: 2012年03期
• 关键词: 无创正压通气 镇静 慢性阻塞性肺疾病 急性加重期 预后

目的:探讨轻度镇静对改善COPD急性加重期(AECOPD)躁动患者无创正压通气预后的影响。方法:89例伴有躁动需要机械通气的AECOPD患者随机分为观察组45例和对照组44例,观察组给予轻度镇静治疗,目标Ramsay评分为2,两组无创正压通气及其他治疗相同。结果:观察组、对照组的气管插管率分别为25%、76%,住ICU时间分别为(8±7)d、(12±9)d,住院时间分别为(13±6)d、(17±10)d,28 d病死率分别为9%、27%,90 d病死率分别为16%、36%。观察组气管插管率较低(P<0.01),住ICU时间、住院时间较短(P均<0.05),28、90 d病死率较低(P<0.05)。结论:轻度镇静可以提高AECOPD伴躁动患者NPPV治疗成功率,减少气管插管率,降低患者病死率,改善患者预后。

Objective: To investigate the effect of mild sedation on the prognosis of non-invasive positive pressure ventilation in patients with agitation caused by acute exacerbation of COPD (AECOPD). Methods: A total of 89 AECOPD patients with agitation requiring mechanical ventilation were randomly divided into observation group (n = 45) and control group (n = 44). The observation group received mild sedation and the target Ramsay score was 2. The two groups were the same with noninvasive positive pressure ventilation . Results: The intubation rates of the tracheal intubation group and the control group were 25% and 76%, respectively. The duration of ICU stay was (8 ± 7) d, (12 ± 9) days, and hospital stay was (13 ± 6) days, (17 ± 10) d, 28 d mortality were 9%, 27%, 90 d mortality were 16%, 36%. The tracheal intubation rate in the observation group was lower (P <0.01), ICU time and hospital stay were shorter (P <0.05), and mortality was lower at 28 and 90 days (P <0.05). Conclusion: Mild sedation can improve the success rate of NPPV treatment in patients with AECOPD and agitation, reduce the rate of tracheal intubation, reduce the mortality and improve the prognosis of patients.