摘要
目的总结对慢性阻塞性肺疾病（ＣＯＰＤ）合并严重呼吸衰竭患者反复多次气管插管（或切开）进行机械通气的经验。方法回顾性分析因ＣＯＰＤ急性加重而机械通气３次以上的１５例患者的临床资料及随访结果。结果１５例患者共机械通气７７例次，其中１例最多通气２０次。脱机拔管成功率８６％，其中气管插管机械通气者平均通气时间１３天，气管切开通气者平均３７天。多次通气最后气管切开者平均通气６４９天。１５例患者首次机械通气后的生存时间１９６～４４２０天，平均１０９３天。中位生存期为１６７３天。１、２、３、５年生存率分别为７３％、６４％、３３％和２５％。死因是多脏器衰竭（ＭＯＦ）或其他脏器严重功能紊乱。结论对晚期ＣＯＰＤ合并严重呼吸衰竭患者实施反复多次的机械通气可延长生存期。重要的是要严格掌握适应证，正确选择人工气道的方法，有创和无创性通气相结合以及恰当应用机械通气的策略。
Objective To summarize the results of patients of severe respiratory failure using multiple times mechnical ventilation (MV) via tracheal intubation (or via tracheotomy). Methods We retrospectively analysed clinical information and follow up results of 15 acute exacerbation of COPD patients using MV more than 3 times. Results MV was used 77 times in 15 patients. The highest number of MV was 20. 86% were weaned successfully. The mean duration of MV via intubation was 13 days and via tracheotomy was 37 days, mean 649 days via the latest brocheotomy after using MV multiple times. The survival duration after the first MV varied from 196 to 4 420 days in 15 patients, mean 1 093 days, medium survival duration of the patients was 1 673 days, survival rates after 1,2,3 and 5 years were 73%, 64%, 33% and 25% respectively. The causes of death were failure of multiple organs or disfunction of other vital organs. Conclusions Repeated application of MV may prolong the survival rates of COPD with severe respiratory failure. It′s important to take strictly the indication of MV, correctly to select the methods of artifical airway, combining invasive and noninvasive ventilation, properly to apply the strategies of MV.
出处
《中华结核和呼吸杂志》
CSCD
北大核心
1999年第2期79-81,共3页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
阻塞性肺疾病
治疗
呼吸衰竭
机械通气
COPD
Pulmonary disease
obstructive
Respiratory failure
Mechanical ventilation
