有创—无创呼吸机序贯治疗在慢性阻塞性肺疾病合并呼吸衰竭中的应用效果(1)
[摘要] 目的 探讨慢性阻塞性肺疾病(COPD)合并呼吸衰竭的有创-无创呼吸机序贯治疗疗效。 方法 选择本院2014年5～11月收治的COPD合并呼吸衰竭患者100例，随机分为序贯组(50例)和有创组(50例)。有创组患者进行有创机械通气至脱机，序贯组患者在有创机械通气后序贯进行无创机械通气。比较两组的疗效，观察两组患者的呼吸机相关性肺炎(VAP)发生率、总机械通气时间、有创通气时间、住院时间。 结果 序贯组有效率为96.00%，有创组有效率为82.00%，序贯组明显高于有创组(χ2=5.005，P<0.05)；序贯组的VAP发生率为2.00%，低于有创组的16.0%(P<0.05)；总机械通气时间、有创通气时间、住院时间均少于有创组，差异有统计学意义(P<0.01)。 结论 有创-无创呼吸机序贯治疗COPD合并呼吸衰竭疗效显著，不良反应发生较少，缩短住院时间，值得临床进一步推广。
[关键词] 慢性阻塞性肺疾病；呼吸衰竭；有创；无创；序贯治疗
[中图分类号] R563.8 [文献标识码] A [文章编号] 1674-4721(2015)05(b)-0032-03
Analysis of sequential therapy of invasive and noninvasive ventilation on chronic obstructive pulmonary disease complicated with respiratory failure
CHEN Gao-ke YUAN Bing-bin CHEN Wei-peng LV Rui
ICU，the People′s Hospital of Gaozhou City in Guangdong Province，Gaozhou 525200，China
[Abstract] Objective To explore the efficacy of sequential therapy of invasive and noninvasive ventilation on chronic obstructive pulmonary disease(COPD) with respiratory failure. Methods 100 patients with COPD complicated with respiratory failure in our hospital from May to November 2014 were randomly divided into sequence group(50 cases) and invasion group (50 cases).Invasion group were given invasive mechanical ventilation till evacuation，sequence group were received sequential therapy of invasive and noninvasive mechanical ventilation.Curative effect，incidence rates of ventilator associated pneumonia (VAP)，total time of ventilation， time of invasive ventilation，and time of hospitalization between two groups was compared respectively. Results The curative effective rate was 96.00% in sequence group，significantly higher than 82.00% in invasion group(P<0.05).The incidence rate of VAP in Sequence group was 2%，less than 16% in invasion group(P<0.05).The total time of ventilation，time of invasive ventilation，and time of hospitalization in sequence group was shorter than that of invasion group respectively，with significant difference(P<0.01). Conclusion The curative effect of sequential therapy of invasive and noninvasive ventilation on COPD complictated with respiratory failure is remarkable，and with less adverse reactions，can short the hospitalization time，is worthy of further promotion.
[Key words] Chronic obstructive pulmonary disease；Respiratory failure；Invasion；Noninvasion；Sequential therapy
慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)是临床常见的一种气道慢性炎性反应性疾病，其发病原因尚不完全清楚，现在研究认为个体易患因素在空气污染、吸烟、感染及有害粉尘等外界环境因素刺激下所致的异常炎性反应。该病的临床特征是气流受限持续存在，处于不完全可逆状态，为进行性发展模式。好发于老年人群，发病急，具有多发性的特点[1]，近年来COPD的发病率呈逐渐升高趋势，严重时期并发呼吸衰竭，急性加重和合并症影响患者生命，加重疾病的严重程度[2]。目前常用、有效治疗COPD并发呼吸衰竭的方法是有创机械通气，虽然能够改善临床症状和体征，但此种方法有创伤性，患者易发生相关性肺炎等一系列并发症，给患者身体带来巨大痛苦，增加经济负担，对整体疗效有一定程度的影响[3-4]。为提高治疗效果，本院采用有创-无创呼吸机序贯治疗COPD合并呼吸衰竭，并与传统治疗方法进行比较。 (陈高科 袁炳斌 陈伟鹏 吕锐)
[关键词] 慢性阻塞性肺疾病；呼吸衰竭；有创；无创；序贯治疗
[中图分类号] R563.8 [文献标识码] A [文章编号] 1674-4721(2015)05(b)-0032-03
Analysis of sequential therapy of invasive and noninvasive ventilation on chronic obstructive pulmonary disease complicated with respiratory failure
CHEN Gao-ke YUAN Bing-bin CHEN Wei-peng LV Rui
ICU，the People′s Hospital of Gaozhou City in Guangdong Province，Gaozhou 525200，China
[Abstract] Objective To explore the efficacy of sequential therapy of invasive and noninvasive ventilation on chronic obstructive pulmonary disease(COPD) with respiratory failure. Methods 100 patients with COPD complicated with respiratory failure in our hospital from May to November 2014 were randomly divided into sequence group(50 cases) and invasion group (50 cases).Invasion group were given invasive mechanical ventilation till evacuation，sequence group were received sequential therapy of invasive and noninvasive mechanical ventilation.Curative effect，incidence rates of ventilator associated pneumonia (VAP)，total time of ventilation， time of invasive ventilation，and time of hospitalization between two groups was compared respectively. Results The curative effective rate was 96.00% in sequence group，significantly higher than 82.00% in invasion group(P<0.05).The incidence rate of VAP in Sequence group was 2%，less than 16% in invasion group(P<0.05).The total time of ventilation，time of invasive ventilation，and time of hospitalization in sequence group was shorter than that of invasion group respectively，with significant difference(P<0.01). Conclusion The curative effect of sequential therapy of invasive and noninvasive ventilation on COPD complictated with respiratory failure is remarkable，and with less adverse reactions，can short the hospitalization time，is worthy of further promotion.
[Key words] Chronic obstructive pulmonary disease；Respiratory failure；Invasion；Noninvasion；Sequential therapy
慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)是临床常见的一种气道慢性炎性反应性疾病，其发病原因尚不完全清楚，现在研究认为个体易患因素在空气污染、吸烟、感染及有害粉尘等外界环境因素刺激下所致的异常炎性反应。该病的临床特征是气流受限持续存在，处于不完全可逆状态，为进行性发展模式。好发于老年人群，发病急，具有多发性的特点[1]，近年来COPD的发病率呈逐渐升高趋势，严重时期并发呼吸衰竭，急性加重和合并症影响患者生命，加重疾病的严重程度[2]。目前常用、有效治疗COPD并发呼吸衰竭的方法是有创机械通气，虽然能够改善临床症状和体征，但此种方法有创伤性，患者易发生相关性肺炎等一系列并发症，给患者身体带来巨大痛苦，增加经济负担，对整体疗效有一定程度的影响[3-4]。为提高治疗效果，本院采用有创-无创呼吸机序贯治疗COPD合并呼吸衰竭，并与传统治疗方法进行比较。 (陈高科 袁炳斌 陈伟鹏 吕锐)