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目的观察慢性阻塞性肺疾病(慢阻肺)合并Ⅱ型呼吸衰竭患者经有创-无创序贯机械通气治疗的临床效果。方法选取2013年3月-2014年4月100例慢阻肺合并Ⅱ型呼吸衰竭患者,采用随机数字表法分为对照组和研究组,每组各50例。对照组给予持续有创通气治疗,研究组采取有创-无创序贯通气治疗。观察两组机械通气时间、入住重症监护病房(ICU)时间、住院时间、治疗前后血清C反应蛋白(CRP)浓度、呼吸机相关性肺炎(VAP)发生率和院内病死率。结果研究组患者入住ICU时间、机械通气时间和住院时间分别为(9.4±8.1)、(10.3±5.8)、(14.7±8.2)d,明显短于对照组的(17.5±10.8)、(15.2±7.7)、(22.8±7.4)d,组间比较差异有统计学意义(P<0.05);研究组患者VAP发生率和院内因VAP病死率分别为4.0%、2.0%,明显低于对照组的22.0%、20.0%,组间比较差异有统计学意义(P<0.05)。结论在慢阻肺合并Ⅱ型呼吸衰竭患者的临床治疗方案中,有创-无创序贯通气治疗方案效果确切,有利于缩短机械通气时间和住院时间,可控制VAP发病率,降低病死率,值得临床推广。
Objective To observe the clinical effect of invasive and noninvasive sequential mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD) and type Ⅱ respiratory failure. Methods From March 2013 to April 2014, 100 patients with chronic obstructive pulmonary disease and type Ⅱ respiratory failure were selected and randomly divided into control group and study group with 50 cases in each group. The control group was given continuous invasive ventilation and the study group was treated with invasive-non-invasive sequential ventilation. The duration of mechanical ventilation, ICU stay, hospital stay, serum C-reactive protein (CRP) level, ventilator-associated pneumonia (VAP) and hospital mortality were observed. Results The ICU stay, mechanical ventilation time and hospital stay in study group were (9.4 ± 8.1), (10.3 ± 5.8) and (14.7 ± 8.2) days, respectively, which were significantly shorter than those in control group (17.5 ± 10.8) and (15.2 ± 7.7) and (22.8 ± 7.4) d, respectively. The difference between the two groups was statistically significant (P <0.05). The incidence of VAP in hospital and VAP in hospital were 4.0% and 2.0% respectively, which was significantly lower than that of the control group 22.0% and 20.0%, respectively. The difference between the two groups was statistically significant (P <0.05). Conclusion In the clinical treatment of patients with COPD and type Ⅱ respiratory failure, invasive and noninvasive sequential ventilation therapy is effective and can shorten the duration of mechanical ventilation and hospital stay, and can control the incidence of VAP and reduce the mortality, which is worth Clinical promotion.