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目的探讨有创-无创序贯面罩双水平气道正压通气治疗慢性阻塞性肺疾病急性加重(AECOPD)合并严重呼吸衰竭的效果。方法AECOPD并严重呼吸衰竭患者55例,入院时给予气管插管机械通气,出现肺部感染控制窗后,序贯组改用序贯B iPAP面罩无创通气,对照组继续常规有创机械通气治疗。观察两组患者撤机前后的动脉血气水平、有创机械通气时间、总机械通气(有创通气+无创通气)时间、呼吸机相关性肺炎的发生率、撤机成功率、住院死亡率。结果序贯组与传统组相比较,两组动脉血气变化差异无统计学意义(P>0.05),两组间有创机械通气时间、呼吸机相关性肺炎发生率、撤机成功率差异有统计学意义(P<0.05),住院死亡率差异无统计学意义(P>0.05)。结论有创-无创序贯性机械通气治疗AECOPD,可以缩短有创通气时间,减少呼吸机相关性肺炎发生率,提高撤机成功率,优于传统有创机械通气方法。
Objective To investigate the effect of bi-level positive airway pressure (CVAP) with invasive and noninvasive sequential masks in treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with severe respiratory failure. Methods AECOPD and severe respiratory failure in 55 patients were admitted to the endotracheal intubation mechanical ventilation, pulmonary infection control window, the sequential group to sequential B iPAP mask non-invasive ventilation, the control group continued conventional mechanical ventilation. The arterial blood gas level, time of invasive mechanical ventilation, total mechanical ventilation (invasive ventilation + noninvasive ventilation), ventilator-associated pneumonia, success rate of weaning and in-hospital mortality were observed before and after weaning. Results Sequential group compared with the traditional group, there was no significant difference in arterial blood gas changes between the two groups (P> 0.05). There was statistical difference between the two groups in duration of invasive mechanical ventilation, incidence of ventilator-associated pneumonia and success rate of weaning Significance of learning (P <0.05), hospital mortality difference was not statistically significant (P> 0.05). Conclusions Innovative noninvasive sequential mechanical ventilation for AECOPD can shorten the duration of invasive ventilation, reduce the incidence of ventilator-associated pneumonia and improve the success rate of weaning, which is superior to traditional invasive mechanical ventilation.