目的:探讨西宁地区慢性阻塞性肺病机械通气人机对抗的原因及处理对策。方法:统计西宁地区(海拔高度为2260m)COPD急性期合并呼吸吸衰竭行机械通气患者39例,均至少发生一次人机对抗。结果:39例患者中发生人机对抗的总例次为62次,其中插管上机立即发生人机对抗19例(30.65%),正常机械通气过程中,后发生人机对抗43例(69.34%),其中肺部感染加重痰液引流不畅8例(12.9%)气道痰痂阻塞110例(16.13%)其他11种因素25例(40.32%)。结论:西宁地区慢性阻塞性肺病机械通气人机对抗的主要原因是不能耐受气管插管,其次是气道痰痂阻塞,痰液引流不畅,加强气道管理有助于改善人机对抗。 Objective: To explore the causes and countermeasures of mechanical ventilation in chronic obstructive pulmonary disease in Xining area. Methods: In Xining area (altitude 2260m), 39 patients with COPD acute respiratory failure and mechanical ventilation were recruited. At least one man-machine confrontation occurred. Results: The total number of man-machine confrontations in 39 patients was 62, of which 19 cases (30.65%) were man-machine confrontation immediately after intubation, 43 cases were man-machine confrontation (69.34%) during normal mechanical ventilation (12.9%), sputum clogged airway obstruction in 110 cases (16.13%) and other 11 factors in 25 cases (40.32%). Conclusion: The main reason of mechanical confrontation of mechanical ventilation in patients with chronic obstructive pulmonary disease in Xining is that it can not tolerate tracheal intubation, followed by obstruction of phlegm scab in airway and poor drainage of sputum. Strengthening airway management can help to improve man-machine confrontation.