标题：序贯性机械通气治疗COPD所致严重呼吸衰竭治疗切换点时间窗的研究

      作者：陈中华
    (岳阳市第一人民医院呼吸内科，湖南 岳阳 414000)

      卷次： 2012年23卷8期

      【摘要】 目的 探讨有创与无创序贯性机械通气治疗慢性阻塞性肺疾病(COPD)所致的严重呼吸衰竭的合
理治疗切换点时间窗。方法 选择我院收治的COPD所致严重呼吸衰竭患者64例随机分为研究组和对照组，每
组32例，两组患者均采用同步间歇指令+压力支持+呼气末正压通气方式，研究组患者采用格拉斯哥昏迷评分作
为切换的时间窗，对照组患者以“肺部感染基本控制”作为时间窗，两组患者到达治疗时间窗后改为鼻面罩PSV+
PEEP方式通气。结果 拔管前两组患者血气分析指标、呼吸频率、心率、pH值差异无统计学意义(P>0.05)，拔管
后两组患者血气分析指标、呼吸频率、心率、pH值与拔管前比较差异均无统计学意义(P>0.05)。研究组有创机械
通气时间、总机械通气时间、住院时间显著低于对照组，VAP发生率显著低于对照组(P<0.05)。两组重新插管率
比较差异无统计学意义(P>0.05)。结论 序贯性机械通气治疗COPD所致的严重呼吸衰竭采用格拉斯哥昏迷评
分作为评价切换的时间窗，早期拔管改用无创通气可以显著提高治疗效果。

      【关键词】 序贯性机械通气；COPD；呼吸衰竭；时间窗

      【中图分类号】 R563 【文献标识码】 A 【文章编号】 1003—6350(2012)08—004—03<

br>Study on the switching points of sequential mechanical ventilation in the treatment of severe respiratory failure
due to COPD.
CHEN Zhong-hua. Department of Respiratory Medicine, the First People's Hospital of Yueyang City,
Yueyang 414000, Hunan, CHINA

【Abstract】 Objective To investigate the switching points of sequential mechanical ventilation in the treat-
ment of severe respiratory failure due to COPD. Methods Sixty-four patients of severe respiratory failure due to
chronic obstructive pulmonary disease (COPD) were randomly divided into the study group and the control group,
each with 32 cases. Patients in the two groups were treated with synchronized intermittent mandatory+PSV+PEEP, but
using Glasgow Coma Scale as a switching time windows in the study group and using "lung infection under control"
as the time windows in the control group patients. Results Before extubation, the blood gas analysis, respiratory
rate, heart rate, pH showed no statistically significant difference between the two groups (P>0.05). And the blood gas
analysis, respiratory rate, heart rate, pH after extubation, in the two groups showed no statistically significant differ-
ence with those before extubation (P> 0.05). In the study group, the time of invasive mechanical ventilation, the total
mechanical ventilation time, length of hospital stay was significantly less than those in the control group, with the inci-
dence of VAP significantly lower (P<0.05). Conclusion For treating severe respiratory failure with COPD, Glasgow
Coma Scale assessment as switching time windows in sequential mechanical ventilation can significantly improve the
therapeutic effect.

      【Key words】 Sequential mechanical ventilation; COPD; Respiratory failure; Time window