CAJ | 학술논문

目的观察应用纤维支气管镜辅助慢性阻塞性肺疾病机械通气序贯撤机的临床疗效.方法将慢性阻塞性肺疾病(COPD)并发呼吸衰竭行气管插管机械通气者随机分为应用纤维支气管镜辅助有创-无创序贯机械通气撤机组(A组,38例)和有创-无创序贯机械通气撤机组(B组,36例),比较两组病例出现肺部感染控制窗(PIC)时间、有创机械通气时间、总机械通气时间、呼吸机相关肺炎(VAP)发生率、首次撤机成功率、RICU住院时间、住院病死率、住RICU费用及住院总费用等指标.结果 A组和B组出现PIC时间分别为(6.0±2.5)d、(8.4±3.6)d,有创机械通气时间分别为(6.3±2.7)d、(8.6±3.5)d,总机械通气时间分别为(9.7±2.8)d、(12.7±4.1)d,住RICU时间分别为(7.9±2.8)d、(10.7±3.5)d,两组指标比较,差异有统计学意义(P<0.01);首次撤机成功例数分别为38、30,总住院费用分别为(28 794±14 618)元、(38 746±22 916)元,住RICU费用分别为(25 936±12 663)元、(35 347±21 696)元,两组指标比较,差异均有统计学意义(P<0.05);A组无一例发生VAP,B组发生4例,A组死亡1例,B组死亡2例,未达到统计学意义.结论应用纤维支气管镜辅助慢性阻塞性肺疾病机械通气序贯撤机能进一步缩短有创通气时间,能取得更好的临床疗效,而且是更经济的治疗方法 .
목적 관찰응용섬유지기관경보조만성조새성폐질병궤계통기서관철궤적림상료효.방법 장만성조새성폐질병(COPD)병발호흡쇠갈행기관삽관궤계통기자수궤분위응용섬유지기관경보조유창-무창서관궤계통기철궤조(A조,38례)화유창-무창서관궤계통기철궤조(B조,36례),비교량조병례출현폐부감염공제창(PIC)시간、유창궤계통기시간、총궤계통기시간、호흡궤상관폐염(VAP)발생솔、수차철궤성공솔、RICU주원시간、주원병사솔、주RICU비용급주원총비용등지표.결과 A조화B조출현PIC시간분별위(6.0±2.5)d、(8.4±3.6)d,유창궤계통기시간분별위(6.3±2.7)d、(8.6±3.5)d,총궤계통기시간분별위(9.7±2.8)d、(12.7±4.1)d,주RICU시간분별위(7.9±2.8)d、(10.7±3.5)d,량조지표비교,차이유통계학의의(P<0.01);수차철궤성공례수분별위38、30,총주원비용분별위(28 794±14 618)원、(38 746±22 916)원,주RICU비용분별위(25 936±12 663)원、(35 347±21 696)원,량조지표비교,차이균유통계학의의(P<0.05);A조무일례발생VAP,B조발생4례,A조사망1례,B조사망2례,미체도통계학의의.결론 응용섬유지기관경보조만성조새성폐질병궤계통기서관철궤능진일보축단유창통기시간,능취득경호적림상료효,이차시경경제적치료방법 .
Objective To observe the efficacy of ventilator weaning in patients with chronic obstructive pulmo-nary diseases (COPD) by sequential invasive to noninvasive ventilation assisted with fiberoptic bronchscopy. Methods The cases were randomly divided into the study group(group A, n = 38) and the control group (group B, n = 36). In group A, patients were treated with bronehoscope combined with sequential noninvasive following invasive mechanical ventilation. In group B, patients were treated with sequential noninvasive following invasive mechanical ventilation. To compare initial time of pulmonary infection control window (PIC window) , the invasive MV duration, the total dura-tion of ventilatory support, the duration of RICU, the successful rate of weaning, hospitalization expenses, mortality rate and the incidence of ventilation - associated pneumonia(VAP). Results For group A and group B, the initial time of PIC window was(6.0 ± 2.5) vs (8.4 ± 3.6) d, P < 0.01 ; the duration of invasive MV was(6.3 ± 2.7) vs (8.6 ± 3.5) d, P < 0.01 ; the total duration of ventilatory support was (9.7 ± 2.8) vs(12.7 ± 4.1) d, P < 0. 01 ; the dura-tion of RICU stay was (7.9 ± 2.8) d vs(10.7 ± 3.5) d, P < 0.01 ; the successful rate of weaning (38/38)vs(30/36), P <0.05;the total hospitalization expenses was (28 794 ± 14 618) yuan vs(38 746 ± 22 916) yuan, P < 0.05 ; the RICU expenses was (25 936 ± 12 663) yuan vs (35 347 ± 21 696) yuan, P < 0. 05. No significant difference in the incidence of VAP and mortality rate. Conclusions The therapy of weaning from mechani-cal ventilation by sequential invasive to noninvasive ventilation assisted with fiberoptic bronchscopy is effective in pa-tients with COPD. It may decrease the duration of invasive MV and hospitalization expenses.