CAJ | 학술논문

目的：探讨以肺部感染控制窗( PIC)联合自主呼吸试验( SBT)在慢阻肺急性加重( AECOPD)患者行序贯通气有创-无创切换治疗中的有效性和安全性。方法将91例需行有创-无创序贯机械通气的AECOPD患者根据切换点的选择分为PIC+SBT组44例和PIC组47例,比较两组VAP发生率、气管插管保留时间、机械通气总时间、ICU住院时间、再次插管率以及死亡率。结果 PIC+SBT组的ICU住院时间以及机械通气总时间小于PIC组且差异显著(P=0．020,<0．001),PIC+SBT组的再次插管率为9．1%远远小于PIC组组的27．6%,差异同样显著(P=0．023),但两组患者VAP发生率和死亡率差异并不显著(P>0．05)。结论 PIC窗联合SBT在AECODP患者序贯通气有创-无创切换可降低再次插管率、机械通气总时间以及ICU住院时间,具有重要临床意义。
목적：탐토이폐부감염공제창( PIC)연합자주호흡시험( SBT)재만조폐급성가중( AECOPD)환자행서관통기유창-무창절환치료중적유효성화안전성。방법장91례수행유창-무창서관궤계통기적AECOPD환자근거절환점적선택분위PIC+SBT조44례화PIC조47례,비교량조VAP발생솔、기관삽관보류시간、궤계통기총시간、ICU주원시간、재차삽관솔이급사망솔。결과 PIC+SBT조적ICU주원시간이급궤계통기총시간소우PIC조차차이현저(P=0．020,<0．001),PIC+SBT조적재차삽관솔위9．1%원원소우PIC조조적27．6%,차이동양현저(P=0．023),단량조환자VAP발생솔화사망솔차이병불현저(P>0．05)。결론 PIC창연합SBT재AECODP환자서관통기유창-무창절환가강저재차삽관솔、궤계통기총시간이급ICU주원시간,구유중요림상의의。
Objective To evaluate the feasibility and the efficacy of early extubation and sequential noninva-sive mechanical ventilation (MV) switched by pulmonary infection control window (PIC window) and spontaneous breathing trials in patients with AECOPD. Methods 91 AECOPD patients treated by sequential noninvasive me-chanical ventilation were divided into the PIC+SBT group (44 cases) and the PIC group (47 cases) by switching point. The rate of ventilator-associated pneumonia ( VAP) , invasive MV duration, days in ICU, re-intubated rate and mortality were measured in the two groups. Results Compared with the PIC group, the PIC+SBT group had shorter duration of invasive MV fewer days in ICU and lower re-intubated rate and mortality. Conclusion Early extubation followed by noninvasive MV initiated at the point of PIC window and SBT can decrease the duration of invasive MV, reduce the re-intubated rate and mortality and improve the prognosis.