摘要目的 评价有创无创序贯机械通气治疗慢性阻塞性肺疾病(COPD)急性加重期合并严重呼吸衰竭的临床疗效.方法 37例COPD急性加重期合并严重呼吸衰竭患者,按其采用机械通气方式不同分为有创无创序贯机械通气治疗组(序贯组19例)与单一有创机械通气治疗组(非序贯组18例)两组.记录并分析比较两组患者机械通气的时间、撤机成功率、呼吸机相关肺炎发生率、入住ICU的时间,并比较序贯组改用无创]通气后的指标.结果 序贯机械通气治疗COPD急性加重期合并严重呼吸衰竭疗效显著,机械通气时间、入住ICU的时间较非序贯组均缩短(P＜0.05),撤机成功率、呼吸机相关肺炎发生率、再插管率均低于非序贯组(P＜0.05).序贯组拔除气管内导管,改用无创机械通气治疗3h后,通气指标、呼吸功能、循环功能与拔管前比较,差异无统计学意义(P＞0.05).结论 应用有创无创序贯机械通气治疗慢性阻塞性肺疾病急性加重期合并严重呼吸衰竭具有优越性,疗效显著.

abstractsObjective To evaluate the effects of noninvasive and invasive sequential mechanical ventilation on chronic obstructive pulmonary disease (COPD) acute exacerbation period with severe respiratory failure.Methods Thirty-seven COPD patients in acute exacerbation period with severe respiratory failure were divided into noninvasive and invasive sequential mechanical ventilation treatment group (sequential group of 19 cases) and single mechanical ventilation treatment group (non-sequential group of 18 cases) according to the different ways of mechanical ventilation.The time of mechanical ventilation,the success rate of mechanical ventilation removement,the machine ventilator-associated pneumonia (VAP) incidence,the time of ICU admission were recorded and compared between the two groups,and the indexes of sequential group during noninvasive ventilation were recorded.Results The effect of sequential mechanical ventilation on COPD acute exacerbation period with severe respiratory failure was good,the mechanical ventilation time,ICU admission time of sequential group were shortened,compared with non-sequential group ( P ＜ 0.05 ).The success rate of mechanical ventilation removement,VAP incidence and reintubation rate were lower than those of the non-sequential group ( P ＜ 0.05 ).In sequential group,after the endotracheval catheter removal,convert to noninvasive mechanical entilation after 3 h,the ventilation indexes,respiratory function,circulation function compared with before drawing tube,there was no significant difference (P ＞ O.05).Conclusions The effect of noninvasive and invasive sequential mechanical ventilation on acute exacerbation period of chronic obstructive pulmonary disease with severe respiratory failure is superior.