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目的应用进口呼吸机有创-无创序贯携氧正压机械通气治疗慢性阻塞性肺疾病急性加重(AECOPD)合并严重呼吸衰竭的临床观察。方法选择2003年3月至2007年3月我院住院的AECOPD并严重呼吸衰竭患者62例,入院时给予气管插管机械通气,待患者神志完全清醒、出现肺部感染控制窗后早期拔管,继续无创呼吸机携氧正压通气治疗,并选择另一家医院同期住院的AECOPD合并严重呼吸衰竭患者60例给予常规有创机械通气治疗作为对照。观察两组患者有创通气时间、总机械通气时间、住院时间、治愈好转率及呼吸机相关性肺炎患病率。结果序贯通气组患者有创机械通气时间(76±8)h、住院时间(18±4)d,与对照组(140±14)h、(25±6)d相比明显缩短,经统计学处理差异有统计学意义(P(0.01)。序贯通气组治愈好转率90.3%(56/62),与对照组76.7%(46/60)相比差异有统计学意义(P(0.05),序贯通气组呼吸机相关性肺炎患病率8.1%(5/62),与对照组21.7%(13/60)相比差异有统计学意义(P(0.01)。结论有创-无创序贯性机械通气治疗慢性阻塞性肺疾病急性加重期合并严重呼吸衰竭安全有效,可以缩短住院时间和有创通气时间,减少呼吸机相关性肺炎发生,提高治愈好转率,优于传统有创机械通气方法。
Objective To evaluate the clinical effects of invasive ventilator invasive and noninvasive sequential positive oxygen pressure mechanical ventilation on patients with acute obstructive pulmonary disease (AECOPD) and severe respiratory failure. Methods From March 2003 to March 2007, 62 hospitalized patients with AECOPD and severe respiratory failure in our hospital were admitted to the hospital with mechanical ventilation of tracheal intubation. When the patients were completely awake, they were extubated after the control window of pulmonary infection. Continue noninvasive ventilator Oxygen Positive Pressure Ventilation, and select another hospital with AECOPD hospitalized with severe respiratory failure in 60 patients given conventional invasive mechanical ventilation as a control. The duration of invasive ventilation, total mechanical ventilation, hospital stay, healing improvement and ventilator-associated pneumonia were observed in two groups. Results Compared with the control group (140 ± 14) h and (25 ± 6) d, the duration of invasive mechanical ventilation was 76 ± 8 h and the length of hospital stay was 18 ± 4 days. The difference was statistically significant (P (0.01) .The improvement rate of sequential ventilation was 90.3% (56/62), which was significantly different from that of control group (76.7%, 46/60) , And the prevalence of ventilator-associated pneumonia in sequential ventilation group was 8.1% (5/62), which was significantly different from that in control group (21.7%, 13/60) (P (0.01) Chronic mechanical ventilation for chronic obstructive pulmonary disease in acute exacerbation combined with severe respiratory failure is safe and effective, can shorten the hospital stay and invasive ventilation time, reduce ventilator-associated pneumonia, improve the cure rate, superior to traditional invasive mechanical ventilation method.