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目的 探讨慢性阻塞性肺疾病 (COPD)急性呼吸衰竭从有创过渡到无创机械通气的适宜时机。方法 2 4例COPD急性呼吸衰竭患者有创机械通气 3天后随机分成两组 ,每组 12例。A组予拔除气管导管改面罩机械通气 ,B组继续有创机械通气。观察两组呼吸机相关性肺炎 (VAP)例数、死亡例数、机械通气时间、住院时间。结果 A、B两组发生VAP的例数分别为 0和 7例 (P =0 0 2 7) ;死亡例数为 0和 3例 (P =0 2 17) ;有创机械通气 3天后尚需机械通气时间为 (7± 5 )天和 (15± 12 )天(P <0 0 5 ) ;住院时间为 (16± 6 )天和 (2 5± 12 )天 (P <0 0 5 )。结论 COPD急性呼吸衰竭有创机械通气 3天后拔除气管导管改面罩机械通气能降低VAP发生率 ,缩短机械通气时间和住院时间。
Objective To explore the appropriate timing of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD) from invasive to noninvasive mechanical ventilation. Methods Twenty-four patients with acute respiratory failure in COPD were randomly divided into two groups (n = 12) after 3 days of invasive mechanical ventilation. A group to remove the endotracheal tube masks mechanical ventilation, B group continued invasive mechanical ventilation. The number of ventilator-associated pneumonia (VAP) cases, the number of deaths, the duration of mechanical ventilation, and the duration of hospital stay were observed. Results The number of VAP cases in group A and group B was 0 and 7 (P = 0 0 2 7) respectively. The number of deaths was 0 and 3 (P = 0 2 17). After 3 days of invasive mechanical ventilation, The duration of mechanical ventilation was (7 ± 5) days and (15 ± 12) days (P <0 05). The length of hospital stay was (16 ± 6) days and (25 ± 12) days (P 0 05). Conclusion Mechanical ventilation of the mask after removal of the endotracheal tube for 3 days after COPD acute respiratory failure can reduce the incidence of VAP and shorten the duration of mechanical ventilation and hospital stay.