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目的探讨慢性阻塞性肺疾病(COPD)并呼吸衰竭患者从有创机械通气转换至无创机械通气时机及效果。方法将28例COPD并呼衰且进行有创机械通气的患者随机分为2组,各14例。A组继续行有创通气,B组拔出气管插管改为面罩无创机械通气。观察两组呼吸机相关肺炎(VAP)例数、病死例数,机械通气时间、住院ICU时间。结果 A组与B组发生VAP的例数分别为8例和1例(P<0.05);死亡例数分别为两例和1例(P>0.05);总机械通气时间分别为(21±9)d和(11±5)d(P<0.05);总住ICU时间分别为(25±10)d和(16±7)d(P<0.05)。结论 COPD并呼吸衰竭行机械通气患者当肺部感染基本控制时改用无创通气可以降低VAP发生率,缩短机械通气时间和住ICU时间。
Objective To investigate the timing and effect of non-invasive mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure who switched from invasive mechanical ventilation. Methods Twenty-eight patients with COPD and respiratory failure and invasive mechanical ventilation were randomly divided into two groups (n = 14 in each group). Group A continued invasive ventilation, B group removed endotracheal intubation mask noninvasive 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 were 8 and 1 (P <0.05), respectively. The number of deaths was 2 and 1, respectively (P> 0.05). The total duration of mechanical ventilation was 21 ± 9 ) d and (11 ± 5) d respectively (P <0.05). The total ICU time was (25 ± 10) days and (16 ± 7) days (P <0.05) respectively. Conclusion Noninvasive ventilation can be used to reduce the incidence of VAP and shorten the time of mechanical ventilation and ICU stay in patients with COPD and respiratory failure when mechanical ventilation is basically controlled.