论文部分内容阅读
目的比较有创与无创序贯通气治疗慢性阻塞性肺病急性加重期的疗效。方法所有患者均入住ICU病房,有创通气采用容量型辅助-控制方式(A/C)以后改为同步间歇强制通气+压力支持方式(SIMV+PSV),然后,根据患者的血气情况和耐受程度逐渐下调呼吸机参数,所有患者均同时应用抗感染、平喘、化痰等常规治疗。序贯通气组逐渐下调直至SIMV为10次/分左右,PSV为10cmH2O左右。如果患者无呼吸困难发生,则拔除气管插管,改用无创通气,IPAP在8～18cmH2O,EPAP在3～5cmH2O,根据血气调整呼吸机参数,直至撤机。对照组则继续采用有创通气,下调SIMV和PSV分别在5次/分和5cmH2O水平,撤机观察,如病情稳定超过4h则拔管。观察两组中机械通气的时间、住ICU时间、VAP的发生、病死率以及撤机的成功与失败的例数。结果有创机械通气时间,序贯组为(10±2)d,而对照组为(19±2)d(P<0.05),住ICU时间序贯组为(14±3)d,而对照组为(24±6)d(P<0.05),发生VAP的例数序贯组为1例,而对照组8例(P<0.05)。结论序贯通气治疗比对照组的机械通气时间,ICU留住时间,VAP的发生例数减少。
Objective To compare the efficacy of invasive and noninvasive sequential ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods All patients were admitted to intensive care unit (ICU). The invasive ventilation was switched to synchronous intermittent mandatory ventilation and pressure support (SIMV + PSV) using volume-assisted AAC (Controlled Anesthesia) method. Gradually reduce the degree of ventilator parameters, all patients also apply anti-infection, asthma, phlegm and other conventional treatment. Sequential ventilation group gradually down until SIMV 10 times / min or so, PSV is about 10cmH2O. If the patient has no breathing difficulties, remove the endotracheal intubation and use noninvasive ventilation. IPAP is 8-18cmH2O and EPAP is 3-5cmH2O. Adjust ventilator parameters according to blood gas until weaning. The control group continued to use invasive ventilation, down SIMV and PSV were 5 times / min and 5cmH2O levels, weaning observation, such as stable condition over 4h extubation. The duration of mechanical ventilation, duration of ICU stay, incidence of VAP, case fatality, and the number of successful and failed weaning cases were observed in both groups. Results The duration of invasive mechanical ventilation was (10 ± 2) days in the sequential group compared with (19 ± 2) days in the control group (14 days) and 14 ± 3 days in the sequential group (24 ± 6) d (P <0.05). The number of cases with VAP in sequential group was 1 case, while that in control group was 8 cases (P <0.05). Conclusions Sequential ventilation has less mechanical ventilation time, ICU retention time, and fewer cases of VAP than control group.