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目的比较序贯机械通气三种切换时点治疗慢性阻塞性肺疾病(COPD)并呼吸衰竭的疗效。方法选取湘西自治州人民医院2011年2月至2014年6月收治的150例COPD并呼吸衰竭患者,采用有创-无创序贯机械通气治疗,随机分为A、B、C三组,其切换时点分别为改良GCS评分达到15分并稳定2 h、出现肺部感染控制窗、自主呼吸试验成功,比较三组患者入住ICU时间、有创通气时间、总机械通气时间、病死率、呼吸机相关性肺炎(VAP)发生率以及再插管率等指标。结果三组患者有创机械通气时间和总机械通气时间比较差异有统计学意义(P<0.05),ICU住院时间比较差异未见统计学意义(P>0.05);三组患者病死率和VAP发生率比较差异未见统计学意义(P>0.05);C组再插管率明显高于A、B组,差异有统计学意义(P<0.05)。结论改良GCS评分能有效改善COPD并呼吸衰竭患者机体状态和整体病情变化,减少有创通气时间,降低ICU住院时间及呼吸机相关性肺炎发生率,值得临床推广应用。
Objective To compare the curative effect of sequential mechanical ventilation at three switching points on chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods 150 patients with COPD and respiratory failure who were admitted to People’s Hospital of Xiangxi Autonomous Prefecture from February 2011 to June 2014 were randomly divided into A, B and C groups, Points were modified GCS score of 15 points and stable 2 h, pulmonary infection control window appears, spontaneous breathing test was successful, the ICU time, invasive ventilation time, total mechanical ventilation time, mortality, ventilator-related Pneumonia (VAP) incidence and re-intubation rate and other indicators. Results There was significant difference in invasive mechanical ventilation time and total mechanical ventilation time between the three groups (P <0.05), but there was no significant difference in ICU length of stay (P> 0.05). The mortality and VAP occurred in three groups There was no significant difference between the two groups (P> 0.05). The re-intubation rate in group C was significantly higher than that in group A and B (P <0.05). Conclusion The improved GCS score can effectively improve the body condition and overall condition of patients with COPD and respiratory failure, reduce the duration of invasive ventilation, reduce the length of hospital stay and the incidence of ventilator-associated pneumonia, which is worthy of clinical application.