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目的:比较有创与无创序贯通气治疗慢性阻塞性肺病急性加重期的疗效。方法:入住ICU的慢性阻塞性肺病急性加重期的患者28例,按通气方法不同分为两组,其中序贯组男10例、女4例,平均年龄(69.4±8.4)岁,对照组男9例、女5例,平均年龄(70.1±4.6)岁;所有患者均先行有创通气治疗,采用容量型辅助-控制方式(A/C),再改为同步间歇强制通气与压力支持方式(SI MV+PSV),然后,根据患者的血气情况和耐受程度逐渐下调呼吸机参数;通气的同时应用抗感染、平喘、化痰等常规治疗。序贯组逐渐下调通气参数至SI MV为10次/分、PSV为10cmH2O左右,如果患者出现肺部感染窗控制,则拔除气管插管改用无创通气,保持IPAP在8～18cmH2O、EPAP在3～5cmH2O水平,根据血气调整呼吸机参数,直至撤机。对照组仍采用有创通气,下调SI MV和PSV分别在5次/分和5cmH2O水平,直至撤机。观察比较两组患者的机械通气时间、住ICU时间、呼吸机相关肺炎的发生率、病死率以及撤机成功和失败的例数。结果:序贯组有创通气时间为(10±2)天、对照组为(19±2)天(P<0.05);序贯组住ICU时间为(14±3)天、对照组为(24±6)天(P<0.05);序贯组发生VAP1例、对照组发生VAP8例(P<0.05)。结论:序贯通气治疗组较对照组的机械通气时间、ICU留住时间、VAP的发生例数均减少。
Objective: To compare the efficacy of invasive and noninvasive sequential ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods: Twenty-eight patients with acute exacerbation of chronic obstructive pulmonary disease admitted to the ICU were divided into two groups according to different ventilation methods. Among them, 10 were male and 4 were female, with an average age of (69.4 ± 8.4) years. In control group, male 9 patients and 5 females, with an average age of (70.1 ± 4.6) years; all patients were treated with invasive ventilation and volume Auxiliary Controlled Mode (A / C), then synchronized intermittent mandatory ventilation and pressure support mode SI MV + PSV), and then, according to the patient’s blood gas levels and tolerance gradually reduce the ventilator parameters; ventilation at the same time the application of anti-infection, asthma, phlegm and other conventional treatment. In sequential group, ventilatory parameters were gradually decreased to SI MV of 10 beats / min and PSV was about 10cmH2O. If the patient had pulmonary infection window control, intubated tracheal intubation was switched to noninvasive ventilation to maintain IPAP at 8 ~ 18cmH2O and EPAP at 3 ~ 5cmH2O level, adjust ventilator parameters according to blood gas, until weaning. The control group was still using invasive ventilation, down SI MV and PSV at 5 times / min and 5cmH2O levels, until weaning. The duration of mechanical ventilation, ICU stay, ventilator-associated pneumonia, mortality, and the number of unsuccessful and unsuccessful patients were compared between the two groups. Results: The duration of invasive ventilation was (10 ± 2) days in sequential group and (19 ± 2) days in control group (P <0.05). The duration of ICU stay in sequential group was (14 ± 3) 24 ± 6) days (P <0.05). There were 1 cases of VAP in sequential group and 8 cases of VAP in control group (P <0.05). Conclusion: The duration of mechanical ventilation, ICU retention time, and the number of VAP cases in sequential ventilation group decreased compared with those in control group.