CAJ | 학술논문

目的：探讨以呼吸泵衰竭改善窗为切换时机序贯通气治疗慢性阻塞性肺疾病（ COPD）并呼吸衰竭的应用价值。方法以COPD并呼吸衰竭经有创机械通气治疗好转，呼吸泵衰竭改善窗出现后的106例患者为研究对象。随机分为有创-无创序贯通气治疗组（序贯通气组）52例和传统治疗组（对照组）54例。序贯通气组立即拔除气管插管，应用无创正压通气支持脱机；对照组以传统有创机械通气方式脱机。比较两组有创机械通气时间、住ICU时间、呼吸机相关性肺炎（ VAP）发生率、再插管率和住院死亡率。结果两组有创机械通气时间分别为（3.9±1.5）d和（15.5±6.1）d，住ICU的时间分别为（4.9±1.8）d和（20.3±5.5）d， VAP发生率分别为15.38％（8/52）和35.19％（19/54），病死率分别为11.54％（6/52）和27.78％（15/54），两组比较差异均有统计学意义（ P均＜0.05）。两组再插管率分别为19.23％（10/52）和16.67％（9/54），差异无统计学意义（ P均＞0.05）。结论对COPD并呼吸衰竭需有创机械通气患者，当呼吸泵衰竭改善窗出现后，立即拔管改无创序贯通气治疗，可以缩短有创通机械通气时间及住 ICU的时间，降低VAP发生率及住院死亡率。
목적：탐토이호흡빙쇠갈개선창위절환시궤서관통기치료만성조새성폐질병（ COPD）병호흡쇠갈적응용개치。방법이COPD병호흡쇠갈경유창궤계통기치료호전，호흡빙쇠갈개선창출현후적106례환자위연구대상。수궤분위유창-무창서관통기치료조（서관통기조）52례화전통치료조（대조조）54례。서관통기조립즉발제기관삽관，응용무창정압통기지지탈궤；대조조이전통유창궤계통기방식탈궤。비교량조유창궤계통기시간、주ICU시간、호흡궤상관성폐염（ VAP）발생솔、재삽관솔화주원사망솔。결과량조유창궤계통기시간분별위（3.9±1.5）d화（15.5±6.1）d，주ICU적시간분별위（4.9±1.8）d화（20.3±5.5）d， VAP발생솔분별위15.38％（8/52）화35.19％（19/54），병사솔분별위11.54％（6/52）화27.78％（15/54），량조비교차이균유통계학의의（ P균＜0.05）。량조재삽관솔분별위19.23％（10/52）화16.67％（9/54），차이무통계학의의（ P균＞0.05）。결론대COPD병호흡쇠갈수유창궤계통기환자，당호흡빙쇠갈개선창출현후，립즉발관개무창서관통기치료，가이축단유창통궤계통기시간급주 ICU적시간，강저VAP발생솔급주원사망솔。
Objective To evaluate the application of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease ( COPD) patients with severe respiratory failure by investigating the appearance of respiratory pump failure improved window ( RPFIW) .Methods COPD patients with severe respira-tory failure receiving invasive mechanical ventilation ( MV) were involved in the study .When the RPFIW appeared by the antibiotic and comprehensive therapy ,106 cases were randomized into invasive-noninvasive sequential mechanical ventilation group and control group .The early extubation was conducted and followed by noninvasive mechanical ven -tilation via facial mask immediately in the sequential mechanical ventilation group .Conventional invasive mechanical ventilation was used as the weaning technique in the control group .The incidence of ventilator-associated pneumonia (VAP),incidence of reintubation and mortality,the duration of invasive mechanical ventilation and days in ICU were analyzed and compared .Results There were 52 cases in the sequential mechanical ventilation group ,54 cases in the control group.In the sequential mechanical ventilation group ,the duration of invasive mechanical ventilation was (3.9 ± 1.5)d,while the duration was(15.5 ±6.1)d in the control group (P<0.05).The durations of ICU stay was(4.9 ± 1.8 ) d in the sequential mechanical ventilation group , ( 20.3 ±5.5 ) d in the control group ( P<0.05 ) .The inci-dence of VAP was 15.38%(8/52) in the sequential mechanical ventilation group ,35.19%(19/54) in the control group respectively ( P <0.05 ) .Hospital mortality was 11.54%( 6/52 ) in the sequential mechanical ventilation group,and 27.78%(15/54) in the control group (P<0.05).The incidence of reintubation was 19.23%(10/52) in the sequential mechanical ventilation group ,16.67%( 9/54 ) in the control group ( P>0.05 ) .Conclusion In those COPD patients requiring invasive mechanical ventilation with severe respiratory failure due to respiratory pump failure,sequential noninvasive following invasive mechanical ventilation at the appearance of respiratory pump failure improved window might significantly reduce duration of invasive mechanical ventilation ,and days in ICU stay ,and de-crease the occurrence of VAP and hospital mortality .