有创机械通气治疗慢性阻塞性肺疾病急性加重合并重度呼吸衰竭的时机探讨

The timing of invasive mechanical ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease patients complicated with severe respiratory failure

  • 摘要: 目的 探讨有创机械通气治疗慢性阻塞性肺疾病急性加重(AECOPD)合并重度呼吸衰竭的最佳时机。 方法 选取AECOPD合并重度呼吸衰竭患者60例作为研究对象,根据不同治疗时机分为观察组与对照组,每组30例。观察组采用早期(6 h内)有创机械通气治疗,对照组采用延期(6 h后)有创机械通气治疗,比较2组血气指标水平、通气时间、ICU入住时间、并发症发生率和病死率。 结果 治疗前, 2组动脉血氧分压[pa(O2)]、动脉血二氧化碳分压[pa(CO2)]、氧合指数(OI)比较,差异无统计学意义(P>0.05); 治疗后,观察组pa(O2)、OI水平高于对照组, pa(CO2)水平低于对照组,差异有统计学意义(P<0.05); 观察组有创通气时间(57.59±14.83)h、机械通气总时间(152.87±27.06)h、ICU入住时间(6.72±1.38)d, 分别短于对照组的(68.72±24.27)h、(179.94±42.51)h、(8.09±2.06)d, 差异有统计学意义(P<0.05); 观察组呼吸机相关性肺炎发生率为10.00%, 低于对照组的33.33%, 差异有统计学意义(P<0.05); 观察组病死率为3.33%, 对照组为10.00%, 差异无统计学意义(P>0.05)。 结论 明确有创通气指征后行早期有创机械通气治疗可有效改善AECOPD合并重度呼吸衰竭患者的血气指标水平,缩短通气时间,减少呼吸机相关性肺炎发生,促进患者尽快恢复。

     

    Abstract: Objective To explore the optimized timing for invasive mechanical ventilation in treating acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients complicated with severe respiratory failure. Methods Sixty patients with AECOPD and severe respiratory failure were selected and divided into two groups according to different treatment timing. The observation group(n=30)was treated with early invasive mechanical ventilation(within 6 hours), and the control group(n=30)was given delayed invasive mechanical ventilation(6 hours later). The blood gas indexes, ventilation time, ICU stay, complication rate and mortality rate of the two groups were compared. Results There were no significant differences in the arterial oxygen partial pressure[pa(O2)], carbon dioxide partial pressure [pa(CO2)], and oxygenation index(OI)between the two groups before treatment(P>0.05); after the treatment, the observation group had significantly higher levels of pa(O2)and OI, and significantly lower pa(CO2)level than those of control group(P<0.05). The invasive ventilation time, the total mechanical ventilation time and the ICU stay time in the observation group were(57.59±14.83)h,(152.87±27.06)h and(6.72±1.38)d respectively, which were significantly shorter than(68.72±24.27)h,(179.94 ±42.51)h and(8.09±2.06)d respectively, in the control group(P<0.05); the incidence of ventilator-associated pneumonia in the observation - group was significantly lower than that in the control group(10.00% versus 33.33%, P<0.05). The mortality rate in the observation group was 3.33%, and 10.00%in the control group,there was no significant difference(P>0.05). Conclusion Early invasive mechanical ventilation for patients with AECOPD and severe respiratory failure after presenting indications of invasive ventilation can effectively improve the patient's blood gas indexes, shorten the ventilation time, reduce ventilator-associated pneumonia, and promote the patient's recovery as soon as possible.

     

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