急性加重期慢阻肺微创气管切开序贯通气应用研究

急性加重期慢阻肺微创气管切开序贯通气应用研究

祝玉成，尚云玲，梁平平，张忠，祝莉丽，张燕，张显鹤，刘芳，荣晨宇

黑龙江省农垦红兴隆管理局中心医院内一科，黑龙江双鸭山155811

[摘要]目的探讨微创经皮扩张气管切开行有创-无创序贯机械通气疗法的临床优势。方法随机选取2012年8月—2014 年10月慢性阻塞性肺疾病患者60例，将患者分为两组，序贯治疗组，在有创机械通气后序贯进行无创机械通气，对照组，有创通气直至脱机，观察两组病例的感染、通气时间、ICU住院时间。结果治疗组和对照组比较，有创机械通气时间分别为(6.3±2.9)d和(13.8±9.5)d (P<0.05)，总机械通气时间分别为(8.1±3.4)d和(13.8±9.5)d (P<0.05)，呼吸机相关性肺炎发生例数分别为0例和5例(P<0.05)，ICU住院时间(9.3±3.1)d和(15.5±7.1)d (P<0.05)。结论慢性阻塞性肺疾病急性发作进行有创-无创序贯机械通气可大大降低有创通气的时间及总的机械通气，缩减了VAP的发生率，减少了住ICU的时长。

[关键词]慢性阻塞性肺疾病；有创-无创序贯机械通气；微创；气管切开

[中图分类号]R563.3

[文献标识码]A

[文章编号]1674-0742（2015）10（a）－0102-02

[作者简介]祝玉成(1969.11-)，男，山东郓城人，本科，主任医师，研究方向：重症医学。

Abstract[]Objective To discuss the advantage of minimally invasive percutaneous dilational tracheostomy and invasive-noninvasive sequential mechanical ventilation in the treatment of acute exacerbation chronic obstructive pulmonary disease.Methods 60 patients with chronic pulmonary disease between August 2012 and October 2014 were divided into two groups.The sequential therapy group was treated with invasive-noninvasive sequential mechanical ventilation, while the control group underwent invasive mechanical ventilation from start to finish.Time of pulmonary infection control window, duration of mechanical ventilation, and length of ICU stay were compared between the two groups.Results The duration of invasive mechanical ventilation was (6.3±2.9) d in the sequential therapy group and (13.8±9.5) d in the control group, P<0.05; the duration of overall mechanical ventilation was (8.1±3.4) d in the sequential therapy group and (13.8±9.5) d in the control group, P<0.05.No ventilator-associated pneumonia was found in the sequential therapy group but 5 cases in the control group.The lengthy of ICU stay was (9.3±3.1) d in the sequential therapy group and (15.5±7.1) d in the control group, P<0.05.Conclusion Invasive-noninvasive sequential mechanical ventilation in the treatment of acute exacerbation chronic obstructive pulmonary disease can significantly reduce the duration of invasive mechanical ventilation and overall mechanical ventilation, lower the ventilator-associated pneumonia rate, and shorten the lengthy of ICU stay.

收稿日期：（2015-07-05）

[基金项目]黑龙江省卫生厅科研课题，课题编号2012—464。

齐艳鹏（1982.11-），男，辽宁沈阳人，硕士，主治医师，研究方向：冠心病相关临床研究。

Minimally Invasive Percutaneous Dilational Tracheostomy and Invasive -noninvasive Sequential Mechanical Ventilation in Treatment of Acute Exacerbation Chronic Obstructive Pulmonary Disease

ZHU Yu-cheng, SHANG Yun-ling, LIANG Ping-ping, ZHANG Zhong, ZHU Li-li, ZHANG Yan, ZHANG Xian-he, LIU Fang, RONG Chen-yu

Insid a section, Central Hospital of the Land Reclamation Hongxinglong Administration, Shuangyashan, Heilongjiang Province, 155811 China

[Key words]Chronic obstructive pulmonary disease; Invasive-noninvasive mechanical ventilation; Minimally invasive tracheostomy

慢性阻塞性肺疾病（COPD）为一种慢性呼吸系统疾病，并以不完全可逆的通气气流受阻为特征，且呈持续性加重的气流受阻症状，常出现急性加重并发呼吸衰竭，病死率高，须及时治疗。其中慢性阻塞性肺疾病急性加重期(AECOPD)是COPD病程中的一个关键阶段。抢救呼吸衰竭的重要手段之一首选有创性机械通气，主要指经人工气道(气管插管或气管切开)通过呼吸机提供气道与肺泡之间的压差，利用压差来改善患者呼吸，然而有创性人工气道的开通，减弱了患者的上呼吸道自然防御能力，通气时间延长易导致呼吸机相关性肺炎（VAP），气压伤等严重并发症，进而带来呼吸机依赖，难以脱机。……