有創(chuàng)—無(wú)創(chuàng)呼吸機(jī)序貫治療在慢性阻塞性肺疾病合并呼吸衰竭中的應(yīng)用效果(1)
[摘要] 目的 探討慢性阻塞性肺疾病(COPD)合并呼吸衰竭的有創(chuàng)-無(wú)創(chuàng)呼吸機(jī)序貫治療療效。 方法 選擇本院2014年5～11月收治的COPD合并呼吸衰竭患者100例，隨機(jī)分為序貫組(50例)和有創(chuàng)組(50例)。有創(chuàng)組患者進(jìn)行有創(chuàng)機(jī)械通氣至脫機(jī)，序貫組患者在有創(chuàng)機(jī)械通氣后序貫進(jìn)行無(wú)創(chuàng)機(jī)械通氣。比較兩組的療效，觀察兩組患者的呼吸機(jī)相關(guān)性肺炎(VAP)發(fā)生率、總機(jī)械通氣時(shí)間、有創(chuàng)通氣時(shí)間、住院時(shí)間。 結(jié)果 序貫組有效率為96.00%，有創(chuàng)組有效率為82.00%，序貫組明顯高于有創(chuàng)組(χ2=5.005，P<0.05)；序貫組的VAP發(fā)生率為2.00%，低于有創(chuàng)組的16.0%(P<0.05)；總機(jī)械通氣時(shí)間、有創(chuàng)通氣時(shí)間、住院時(shí)間均少于有創(chuàng)組，差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。 結(jié)論 有創(chuàng)-無(wú)創(chuàng)呼吸機(jī)序貫治療COPD合并呼吸衰竭療效顯著，不良反應(yīng)發(fā)生較少，縮短住院時(shí)間，值得臨床進(jìn)一步推廣。
[關(guān)鍵詞] 慢性阻塞性肺疾病；呼吸衰竭；有創(chuàng)；無(wú)創(chuàng)；序貫治療
[中圖分類號(hào)] R563.8 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 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)是臨床常見(jiàn)的一種氣道慢性炎性反應(yīng)性疾病，其發(fā)病原因尚不完全清楚，現(xiàn)在研究認(rèn)為個(gè)體易患因素在空氣污染、吸煙、感染及有害粉塵等外界環(huán)境因素刺激下所致的異常炎性反應(yīng)。該病的臨床特征是氣流受限持續(xù)存在，處于不完全可逆狀態(tài)，為進(jìn)行性發(fā)展模式。好發(fā)于老年人群，發(fā)病急，具有多發(fā)性的特點(diǎn)[1]，近年來(lái)COPD的發(fā)病率呈逐漸升高趨勢(shì)，嚴(yán)重時(shí)期并發(fā)呼吸衰竭，急性加重和合并癥影響患者生命，加重疾病的嚴(yán)重程度[2]。目前常用、有效治療COPD并發(fā)呼吸衰竭的方法是有創(chuàng)機(jī)械通氣，雖然能夠改善臨床癥狀和體征，但此種方法有創(chuàng)傷性，患者易發(fā)生相關(guān)性肺炎等一系列并發(fā)癥，給患者身體帶來(lái)巨大痛苦，增加經(jīng)濟(jì)負(fù)擔(dān)，對(duì)整體療效有一定程度的影響[3-4]。為提高治療效果，本院采用有創(chuàng)-無(wú)創(chuàng)呼吸機(jī)序貫治療COPD合并呼吸衰竭，并與傳統(tǒng)治療方法進(jìn)行比較。 (陳高科 袁炳斌 陳偉鵬 呂銳)
[關(guān)鍵詞] 慢性阻塞性肺疾病；呼吸衰竭；有創(chuàng)；無(wú)創(chuàng)；序貫治療
[中圖分類號(hào)] R563.8 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 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)是臨床常見(jiàn)的一種氣道慢性炎性反應(yīng)性疾病，其發(fā)病原因尚不完全清楚，現(xiàn)在研究認(rèn)為個(gè)體易患因素在空氣污染、吸煙、感染及有害粉塵等外界環(huán)境因素刺激下所致的異常炎性反應(yīng)。該病的臨床特征是氣流受限持續(xù)存在，處于不完全可逆狀態(tài)，為進(jìn)行性發(fā)展模式。好發(fā)于老年人群，發(fā)病急，具有多發(fā)性的特點(diǎn)[1]，近年來(lái)COPD的發(fā)病率呈逐漸升高趨勢(shì)，嚴(yán)重時(shí)期并發(fā)呼吸衰竭，急性加重和合并癥影響患者生命，加重疾病的嚴(yán)重程度[2]。目前常用、有效治療COPD并發(fā)呼吸衰竭的方法是有創(chuàng)機(jī)械通氣，雖然能夠改善臨床癥狀和體征，但此種方法有創(chuàng)傷性，患者易發(fā)生相關(guān)性肺炎等一系列并發(fā)癥，給患者身體帶來(lái)巨大痛苦，增加經(jīng)濟(jì)負(fù)擔(dān)，對(duì)整體療效有一定程度的影響[3-4]。為提高治療效果，本院采用有創(chuàng)-無(wú)創(chuàng)呼吸機(jī)序貫治療COPD合并呼吸衰竭，并與傳統(tǒng)治療方法進(jìn)行比較。 (陳高科 袁炳斌 陳偉鵬 呂銳)