黄冠宇++苏民++江勇++邓明汉+++邓洁++覃秋乙++黄力

[摘要]目的 观察有创-无创呼吸机序贯治疗在慢性阻塞性肺疾病（COPD）合并急性呼吸衰竭中的临床效果。方法 选取我院2014年1月～2016年10月收治的78例COPD合并急性呼吸衰竭患者，将患者采用随机数字表法分为两组，每组39例。对照组患者进行常规有创通气治疗，观察组患者进行有创-无创呼吸机序贯治疗。比较两组患者的临床效果。结果 观察组患者的有创通气时间、通气治疗总体耗时、入住ICU时间为（5.2±1.5）、（11.8±2.4）、（11±2）d，明显短于对照组[（15.5±4.0）、（14.0±5.0）、（16±4）d]（P<0.05）；观察组患者的再插管率为7.7%，VAP发生率为5.1%，明显低于对照组的25.6%、23.1%（P<0.05）。结论 在慢性阻塞性肺疾病合并急性呼吸衰竭患者中应用有创-无创呼吸机序贯治疗安全有效，值得推广。

[关键词]有创-无创呼吸机序贯治疗；慢性阻塞性肺疾病；急性呼吸衰竭；临床效果

[中图分类号] R563.1+9 [文献标识码] A [文章编号] 1674-4721（2017）06（b）-0042-03

[Abstract]Objective To observe the clinical effect of invasive and non-invasive ventilation sequential therapy in patients with chronic obstructive pulmonary disease （COPD） complicated with acute respiratory failure.Methods 78 cases with COPD complicated with acute respiratory failure treated in our hospital from January 2014 to October 2016 were selected and they were divided into the two groups according to the random number table method and there were 39 cases in each group.The patients in the control group were given the routine invasive ventilation treatment，while the patients in the observation group were given invasive and non-invasive ventilation sequential therapy.The clinical effect were compared between the two groups.Results The duration of invasive ventilation，overall time of ventilation treatment and ICU stay time [（5.2±1.5），（11.8±2.4），（11±2）d respectively] in patients of observation group obviously were shorter than those of control group [（15.5±4.0），（14.0±5.0），（16±4）d] （P<0.05） and the re-intubation rate was 7.7%，the incidence of VAP was 5.1% in the patients of observation group were obviously lower than those of control group （25.6%，23.1%） （P < 0.05）.Conclusion Invasive and non-invasive ventilation sequential therapy in patients with COPD complicated with acute respiratory failure is safe and effective，and it is worthy of promotion，in patients with chronic obstructive pulmonary disease in patients with acute respiratory failure in the application of noninvasive ventilator sequential treatment Treatment is safe and effective， worthy of promotion

[Key words]Invasive and non-invasive ventilation sequential therapy；Chronic obstructive pulmonary disease；Acute respiratory failure；Clinical effect

慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）多見于老年人，患者常伴急性呼吸衰竭，临床上通常采用机械通气治疗[1]。经临床实践发现，部分患者会时常产生呼吸机依赖，撤机失败率较高[2]。近年来，在治疗急性呼吸衰竭时应用有创-无创呼吸机序贯治疗的效果良好，为撤机操作提供了全新思路。本文以78例COPD合并急性呼吸衰竭患者为研究对象，观察有创-无创呼吸机序贯治疗在COPD合并急性呼吸衰竭中的临床效果，现报道如下。

1 资料与方法

1.1 一般资料

本研究经医院医学伦理委员会批准，并征得患者知情同意。选取2014年1月～2016年10月在我院接受治疗的78例COPD合并急性呼吸衰竭患者，全部患者均符合诊断标准，排除合并其他中枢神经疾病、心源性休克、严重心律失常、严重电解质紊乱、近期行消化道手术者。COPD患者因支气管、肺部感染导致急性加重，合并急性呼吸衰竭，部分患者伴有意识障碍，需要进行通气治疗。……