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目的探讨有创-无创序贯通气治疗慢性阻塞性肺部疾病急性加重(acute exacerbation chronic obstructive pulmonary disease,AECOPD)合并Ⅱ型呼吸衰竭的临床疗效。方法选择2013年1月-2014年6月收治的AECOPD合并Ⅱ型呼吸衰竭患者56例,随机分为对照组和观察组各28例。两组均给予常规治疗,采用经口气管插管机械通气,观察组在出现肺部感染控制窗后给予无创通气,对照组则继续行有创通气,逐渐脱机。比较两组患者有创机械通气时间及呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)发生率、拔管成功率、再插管率、病死率等方面的差异。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果观察组有创机械通气时间为(4.8±1.5)d,明显短于对照组的(13.9±2.0)d,差异有统计学意义(P<0.05)。观察组拔管成功率及再插管率分别为92.86%、3.57%,对照组为57.14%、28.57%,差异均有统计学意义(均P<0.05)。观察组p H值、Pa O2、Pa CO2分别为(7.46±0.37)、(88.3±12.6)、(49.2±5.3)mm Hg(1 mm Hg=0.133 k Pa),对照组分别为(7.19±0.43)、(69.7±10.3)、(77.3±5.8)mm Hg,差异均有统计学意义(均P<0.05)。结论应用有创-无创序贯通气治疗AECOPD合并Ⅱ型呼吸衰竭疗效确切,能有效降低拔管成功率、再插管率和病死率,提高治疗效果,缩短住院时间,值得在临床上进一步推广。
Objective To investigate the clinical efficacy of invasive-noninvasive sequential ventilation in the treatment of acute exacerbation chronic obstructive pulmonary disease (AECOPD) with type Ⅱ respiratory failure. Methods From January 2013 to June 2014, 56 AECOPD patients with type Ⅱ respiratory failure were randomly divided into control group and observation group with 28 cases each. Both groups were given routine treatment with mechanical ventilation via orotracheal intubation. The observation group was given non-invasive ventilation after the control window of pulmonary infection, while the control group continued invasive ventilation and gradually went offline. The differences of invasive mechanical ventilation time, ventilator-associated pneumonia (VAP) incidence rate, extubation success rate, reintubation rate and mortality were compared between the two groups. Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The duration of invasive mechanical ventilation in the observation group was (4.8 ± 1.5) d, which was significantly shorter than that in the control group (13.9 ± 2.0) d, with significant difference (P <0.05). The success rate of extubation and the rate of reintubation in the observation group were 92.86% and 3.57%, respectively. The control group was 57.14% and 28.57%, respectively. The difference was statistically significant (both P <0.05). The values of p H, Pa O2 and Pa CO2 in the observation group were (7.46 ± 0.37), (88.3 ± 12.6) and (49.2 ± 5.3) mm Hg (1 mm Hg = 0.133 k Pa) respectively in the observation group and (7.19 ± 0.43 ), (69.7 ± 10.3) and (77.3 ± 5.8) mm Hg respectively, all with statistical significance (all P <0.05). Conclusions The application of invasive and noninvasive sequential ventilation in the treatment of AECOPD combined with type Ⅱ respiratory failure has definite curative effect, which can effectively reduce the success rate of extubation, reintubation rate and mortality, improve the curative effect and shorten the length of hospital stay. It is worth to be further popularized clinically.