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慢性阻塞性肺疾病急性发作伴Ⅱ型呼吸衰竭合并急性左心衰竭撤机的研究

  

  1. 北京市门头沟区医院  重症医学科,北京 102300
  • 出版日期:2017-05-05 发布日期:2017-05-05
  • 通讯作者: 通信作者:王建军,Email:wjj999315@163.com

Withdrawing  mechanical ventilation in acute exacerbation and type  Ⅱ  respiratory failure in chronic obstructive pulmonary disease with acute heart failure

  1. Department of Critical Care Medicine, Beijing Mentougou  District Hospital, Beijing 102300,China
  • Online:2017-05-05 Published:2017-05-05
  • Contact: Corresponding author: Wang Jianjun, Email:wjj999315@163.co

摘要: 目的探讨慢性阻塞性肺病急性发作(AECOPD)伴Ⅱ型呼吸衰竭合并急性左心衰竭撤机的不同方法。方法选择AECOPD伴Ⅱ型呼吸衰竭同时合并急性左心衰竭需要有创呼吸机通气的患者42例,随机分为研究A组和研究B组,研究A组采用“以肺部感染控制窗”(PIC)为切换点行有创与无创序贯机械通气撤机方法,研究B组采用自主呼吸试验(SBT)成功后接有创-无创序贯撤机方法。观察两组有创通气时间、48小时再插管率、呼吸机相关性肺炎(VAP)发生率、住重症监护病房(ICU)时间、病死率、总通气时间和住院时间。结果两组有创通气时间、48小时再插管率、VAP发生率、住ICU时间和病死率方面比较差异均无统计学意义(P>0.05);研究A组在总通气时间,住院时间较研究B组延长(P<0.05)。结论以“PIC”窗为切换点行有创与无创序贯机械通气撤机与采用SBT有创-无创序贯撤机相比并未获益,且总机械通气时间、住院时间延长。

关键词: 肺疾病, 慢性阻塞性;心力衰竭;通气机撤除法

Abstract: ObjectiveTo  investigate the different methods of withdrawing mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with type Ⅱ respiratory failure and acute heart failure (HF). Methods A  prospective,randomized,doubleblinded tudy was performed  in 42 AECOPD patients with type Ⅱ respiratory failure and HF suffering from mechanical ventilation,and the patients were randomly divided into two groups, including  20 cases in study   group A and 22 cases in study group B.The patients  in study group A got   early extubation and sequential noninvasive mechanical ventilation switched by pulmonary infection control window(PIC window),while those in study group B after spontaneous breathing trial(SBT) had  immediate extubation and  received sequential noninvasive mechanical ventilation. The duration of invasive mechanical ventilation,48 hourintubation rate,the duration of ICU stay,the total duration of ventilatory,inhospital mortality, rate of ventilatorassociated pneumonia(VAP) and the duration of hospital stay were compared between two groups. ResultsThe duration of invasive mechanical ventilation,48 hourintubation rate,the duration of ICU stay,inhospital mortality and rate of ventilatorassociated pneumonia(VAP) were not significantly  different  between two groups(P>0.05).The total duration of ventilatory(t=2.135,P=0.039)  and the duration of hospital stay(t=2.098,P=0.042)  were significantly  different between two groups(P<0.05).ConclusionThe comparison showed no benefit for PIC window at withdrawing sequential noninvasive and invasive mechanical ventilation with SBT's sequential noninvasive and invasive mechanical ventilation. The total duration of ventilation and the duration of hospital stay in study group A were  longer in study group B.

Key words: pulmonary disease, chronic obstructive, heart , failure, ventilator weaning