摘要
目的观察急性加重期慢性阻塞性肺疾病患者行气管插管有创机械通气采用无创正压通气过渡撤机的临床疗效和安全性。方法选取本院2016年1月-2016年12月收治的急性加重期慢性阻塞性肺疾病行气管插管有创通气的患者40例,随机分为研究组(NIPPV组)20例和对照组20例,对照组患者采用常规低水平压力支持通气方式撤机,研究组患者选择气管拔管后立即行无创正压通气过渡撤机,比较两组患者的总机械通气时间、动脉血气值、再插管率、呼吸机相关性肺炎发生率和病死率。结果两组患者动脉血气指标(pH、PaO_2、PaCO_2、SaO_2)三个时间点(拔管前、拔管后2h、拔管后24h)组间比较和组内比较均无明显差异(P> 0.05);NIPPV组有创通气时间明显缩短(205.2±28.2h vs 110.8±30.5h,P<0.05),呼吸相关性肺炎发生率和病死率均低于常规撤机组(P<0.05)。结论 AECOPD行有创机械通气采用NIPPV的过渡撤机模式可明显减少有创通气时间,减少VAP的发生率和疾病的病死率,改善患者的总预后。
Objective To observe the clinical efficacy and safety of tracheal intubation with invasive mechanical ventilation and noninvasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease. Methods From January 2016 to December 2016, 40 patients with acute exacerbation chronic obstructive pulmonary disease(COPD)undergoing tracheal intubation were randomly divided into two groups: NIPPV group(n = 20)and control group(n = 20). The patients in the control group were removed by conventional low-level pressure support ventilation, and the patients in the study group were treated with non-invasive positive pressure ventilation immediately after tracheal extubation. The total mechanical ventilation time, arterial blood gas value,re-intubation rate, Incidence and mortality of ventilator-associated pneumonia were compared between the two groups. Results There was no significant difference in arterial blood gas index(p H,PaO2,Pa CO2,Sa O2)between the two groups(before extubation, 2 hours after extubation and 24 hours after extubation)(P > 0. 05). The time of invasive ventilation in NIPPV group was significantly shortened(205.2±28.2 h vs, 110.8 ±30.5 h, P < 0.05), and the incidence and mortality of respiratory associated pneumonia were lower than those of routine evacuation unit(P < 0.05). Conclusion The transient weaning mode of NIPPV in AECOPD with invasive mechanical ventilation can significantly reduce the duration of invasive ventilation, reduce the incidence of VAP and the mortality of disease, and improve the overall prognosis of the patients.
作者
王志飞
王小琴
WANG Zhi fei;WANG Xiao qin(Department of respiratory medicine,Xinjiang general hospital of Lanzhou liberation army,Xinjiang,Urumqi,830000,China)
出处
《新疆医学》
2018年第10期1079-1082,共4页
Xinjiang Medical Journal
关键词
无创正压通气
慢性阻塞性肺疾病
机械通气
过渡
撤机
Noninvasive positive pressure ventilation
Chronic obstructive pulmonary disease
Mechanical ventilation
Transition
ventilator
