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目的研究经鼻有创无创序贯性机械通气抢救急性加重期慢性阻塞性肺疾病的临床效果。方法分别利用经鼻有创无创序贯性机械通气、经口有创无创序贯性机械通气等方法对重症呼吸衰竭进行临床治疗,对呼吸频率(RR)、心率(HR)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)及白细胞计数、总机械通气时间、有创通气时间、呼吸机相关性肺炎发生率、镇静剂使用次数、脱机成功率、住院病死率、住院费用等指标进行统计分析。结果利用经鼻有创无创序贯通气治疗重症呼吸衰竭患者不仅能有效地改善患者的RR、HR、PaCO2、PaO2及白细胞计数等生理指标,而且较经口有创无创气管插管明显减少了有创通气时间、总机械通气时间、治疗期间的镇静剂使用次数及总住院费用,差异均有统计学意义(P<0.05、<0.01或<0.001)。结论经鼻有创无创序贯性机械通气能有效地改善重症呼吸衰竭患者的生理指标,还能更有效地改善重症呼吸衰竭患者治疗期间的生活质量。
Objective To study the clinical effect of nasal invasive non-invasive sequential mechanical ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods The patients with severe respiratory failure were treated by nasal invasive non-invasive sequential mechanical ventilation and oral invasive invasive sequential mechanical ventilation. Respiratory rate (RR), heart rate (HR), arterial carbon dioxide PaCO2, PaO2 and WBC count, total duration of mechanical ventilation, duration of invasive ventilation, incidence of ventilator-associated pneumonia, frequency of sedation use, off-line success rate, in-hospital mortality, hospitalization costs And other indicators for statistical analysis. Results The use of nasal invasive and noninvasive sequential ventilation in the treatment of patients with severe respiratory failure can not only effectively improve the physiological indexes such as RR, HR, PaCO2, PaO2 and white blood cell count, but also reduce significantly compared with those without oral tracheal intubation The duration of invasive ventilation, total mechanical ventilation, the number of sedatives used during treatment and total hospitalization costs were significantly different (P <0.05, <0.01 or <0.001). Conclusion Nasal, invasive and non-invasive sequential mechanical ventilation can effectively improve the physiological index of patients with severe respiratory failure, but also can effectively improve the quality of life of patients with severe respiratory failure during treatment.