双相气道正压通气在慢性阻塞性肺疾病患者有创机械通气撤机中的应用

目的探讨双相气道正压通气在慢性阻塞性肺疾病（COPD）重度Ⅱ型呼吸衰竭撤机中的应用价值。方法COPD呼吸衰竭行有创机械通气患者41例，随机分为治疗组2l例与对照组20例。出现肺部感染控制窗时治疗组拔除气管内导管，应用BiPAP通气方式行无创通气，对照组按照常规方法逐步撤机。主要观测指标为：有创通气时间、机械通气总时间、撤机成功率、呼吸机相关肺炎（VAP）发生率和院内病死率。结果出现肺部感染控制窗时两组资料相比差异均无统计学意义（P均〉0．05）。治疗组拔管时与应用双相气道正压通气2h相比，心率、呼吸、动脉血气差异均无统计学意义（P均〉0．05）。治疗组的有创通气时间较对照组缩短（6．9±3．0）d与（13．1±4．3）dt=5．38，P〈0．01]；VAP发生率较对照组降低48％（1／21）与40％（8／20）]，X^2=5．51，P=0．02]，撤机成功率较对照组提高95％（20／21）与65％（13／20），X^2=4．19，P=0．04]。但两组机械通气总时间、院内病死率相比差异均无统计学意义（P均〉0．05）。结论当COPD上机患者出现肺部感染控制窗时，应用双相气道正压通气方式撤机可缩短有创通气时间、降低VAP发生率、提高撤机成功率。

Study on clinical application of bi-level positive airway pressure after removal of endotracheal intubation for Chronic Obstructive Pulmonary Disease complicated with type II respiratory failure

Objective To evaluate the therapeutic effects of noninvasive bi-level positive airway pressure （BiPAP） ventilation after extubation in chronic obstructive pulmonary disease （COPD） complicated with type Ⅱ respiratory failure. Methods Forty-one intubated COPD cases with severe respiratory failure due to pulmonary infection （ pneumonia or purulent bronchitis） were involved in the study. At the time of pulmonary infection control （PIC） window, the extubation was conducted and followed by BiPAP ventilation in 21 cases （ the experimental group）, while the other 20 COPD cases with similar clinical characteristics, as the control group,who continuously received invasive mechanical ventilation after PIC window. Outcomes including the duration of invasive ventilation, the total duration of ventilation support, success rate, the incidence of ventilator associated pneumonia （VAP） and mortality rate were observed and compared between the two groups. Results The two groups had similar clinical characteristics and gas exchange at the time of PIC window （P 〉 0.05 ） Compared with the control group, the experimental group had shorter duration of invasive mechanical ventilation （6.9±3.0） d vs. （13.1±4.3） d,t =5.38,P 〈0.001）,lower rate of VAP （1/20 vs. 8/20,X2 =5.51,P= 0. 02） and higher extubation rate （20/21 vs. 13/20, X2 = 4. 19,P = 0. 04）. Conclusion In COPD patients with intubation and mechanical ventilation for respiratory failure, BiPAP ventilation after extubation at the point of PIC window may improve patients＇ prognosis.