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目的探讨肺部感染控制窗(PIC)联合自主呼吸试验(SBT)在慢性阻塞性肺疾病(CODP)患者序贯通气行有创-无创切换的有效性和安全性。方法将71例需行有创-无创序贯机械通气的COPD合并呼吸衰竭患者根据切换点的选择分为PIC+SBT组34例和PIC组37例,比较两组呼吸机相关肺炎发生率、气管插管保留时间、机械通气总时间、ICU住院时间、再次插管率以及死亡率。结果 PIC+SBT组的ICU住院时间、有创通气时间以及机械通气总时间分别为(15.9±8.7)d、(10.2±2.4)d、(12.1±4.6)d,小于PIC组的(20.0±7.9)d、(13.7±3.9)d、(16.6±4.5)d,差异具有统计学意义(t值分别为2.589、4.506、4.165,均P<0.05),PIC+SBT组的再次插管的患者为4例(11.8%),远远少于PIC组的12例(32.4%),差异有统计学意义(χ2=4.225,P<0.05),但两组呼吸机相关肺炎发生率和病死率差异无统计学意义(χ2值分别为0.208和1.492,均P>0.05)。结论 PIC窗联合SBT在CODP合并呼吸衰竭患者序贯通气行有创-无创切换可降低再次插管率、机械通气总时间以及ICU住院时间,具有重要临床意义。
Objective To investigate the efficacy and safety of sequential pneumoconiosis (PIC) combined with spontaneous breathing test (SBT) for sequential invasive ventilation in patients with chronic obstructive pulmonary disease (CODP). Methods Seventy-one patients with COPD and respiratory failure requiring invasive or non-invasive sequential ventilation were divided into PIC + SBT group (n = 34) and PIC group (n = 37) according to the selection of switching point. The incidence of ventilator-associated pneumonia Intubation retention time, total duration of mechanical ventilation, ICU stay, reintubation rate, and mortality. Results The length of hospital stay, invasive ventilation and mechanical ventilation in PIC + SBT group were (15.9 ± 8.7) days, (10.2 ± 2.4) days and (12.1 ± 4.6) days, respectively, which were less than those in PIC group (20.0 ± 7.9 days) ), d (13.7 ± 3.9) d, (16.6 ± 4.5) d respectively, the difference was statistically significant (t = 2.589, 4.506, 4.165, 4 cases (11.8%), far less than PIC group, 12 cases (32.4%), the difference was statistically significant (χ2 = 4.225, P <0.05), but the incidence of ventilator- Statistical significance (χ2 values were 0.208 and 1.492, all P> 0.05). CONCLUSION: Sequential ventilation of PIC window combined with SBT in patients with CODP complicated with respiratory failure can reduce the rate of reintubation, the total time of mechanical ventilation and the duration of ICU stay, which is of great clinical significance.