摘要
目的探讨治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭以改良格拉斯哥昏迷量表评分(GCS)≥13分作为有创-无创序贯通气切换点的效果。方法将80例COPD合并呼吸衰竭患者按随机数字表法分为改良GCS≥13分组(A组)和改良GCS≥10分组(B组),每组40例。A组患者在有创机械通气(改良GCS≥13分)后序贯进行无创机械通气,B组患者在有创机械通气(改良GCS≥10分)后序贯进行无创机械通气。比较两组患者的呼吸机相关性肺炎(VAP)发生率、再次插管发生率、有创通气时间、住院时间。结果与B组比较,A组有创通气时间明显降低(P<0.05);两组患者VAP发生率、再次气管插率、住院总时间方面比较差异均无统计学意义(均P>0.05);两组拔除气管插管前及无创机械通气3h后氧合指数、平均动脉压、PaO_2、PaCO_2等比较差异均无统计学意义(均P>0.05)。结论治疗COPD合并呼吸衰竭以改良GCS≥13分作为有创-无创序贯通气切换点有助于改善治疗效果。
Objective the To analyze the effectiveness and feasibility in of using improved Glasgow coma scale（GCS）score 13with as switching point for invasive to noninvasive COPD ventilation with chronic obstructive in pulmonary randomly disease divided（COPD）into patients A respiratory group failure.Methods Eighty patients respiratory failure ICU were group（n=40）and B（n=40）.In group A,the endotracheal tube was extubated and the noninvasive ventilation was used when the improved GCS score score reached was 13;in group The B,the endotracheal tube was extubated and noninvasive ventilation need was used when time the GCS of 10 reached.time incidence rate of ventilator associated pneumonia（VAP）,of to reintubation,group of of invasive invasive ventilation ventilation incidence and in of A hospitalization was were compared between two groups.Results Compared B,the time group rates significantly rate lower（P〈0.05）.There were no significant differences between group A and group B in the of VAP,of reintuhation,length of hospital stay（all P〈0.05）.There were no significant differences and in oxygenation extubation index,（all mean arterial pressure,oxygen using partial improved effect pressure,GCS carbon dioxide partial pressure point before invasive 3h after P〈0.05）.Conclusion improve The of score of 13 with as the switching for to noninvasive ventilation can significantly the therapeutic in COPD patients respiratory failure.
作者
林肖琴
张近波
张丽红
朱金强
宋于康
金晓红
鄢来超
董美平
曹烈祥
吴仙丹
LIN Xiaoqin;ZHANG Jinbo;ZHANG Lihong(Department of EICU,Wenling Hospital Affiliated to Wenzhou Medical College,Wenling 317500,China)
出处
《浙江医学》
CAS
2018年第16期1823-1826,共4页
Zhejiang Medical Journal
基金
温岭市科技局课题(2014C31BA0032)
关键词
呼吸衰竭
慢性阻塞性肺疾病
改良格拉斯哥昏迷评分
机械通气
撤机
Respiratory failure
Chronic obstructive pulmonary disease （COPD）
Improved glasgow coma scalescore
Mechanical ventilation
Ventilator weaning
