目的探讨以肺部感染控制窗为切换点进行有创无创序贯性机械通气治疗慢性阻塞性肺病(COPD)呼吸衰竭的应用价值。方法将40例诊断为COPD并呼吸衰竭需机械通气的患者作为研究对象。经抗感染及综合治疗,当出现肺部感染控制窗时,随机分为有创无创序贯治疗组(序贯组)和常规治疗组(对照组)。序贯组患者行拔除气管插管改用无创机械通气,无创机械通气采用BiPAP呼吸机,对照组以常规有创机械通气方式脱机。观察两组患者一般情况、动脉血气分析指标、住院时间、机械通气时间、呼吸机相关性肺炎(VAP)和死亡率的发生情况。结果序贯组和对照组治疗前各指标均无统计学意义(均P>0.05)。序贯组患者无创机械通气3 h时的循环指标和呼吸指标与拔管前比较,差异均无统计学意义(均P>0.05)。序贯组和对照组有创机械通气时间分别为(7.3±3.0)d和(23.2±16.1)d,总机械通气时间分别为(13.6±8.2)d和(23.2±16.1)d,住院时间为(14.8±5.6)d和(25.7±7.8)d,VAP发生率分别为9.52%和52.63%,两组比较差异均有统计学意义(均P<0.05)。病死率分别为4.76%和5.26%,两组比较差异无统计学意义(P>0.05)。结论以肺部感染控制窗为切换点,采用有创无创序贯性机械通气治疗COPD呼吸衰竭患者,可以缩短有创机械通气时间及住院时间,降低VAP的发生率。 Objective To explore the value of using invasive non-invasive sequential mechanical ventilation in the treatment of chronic obstructive pulmonary disease (COPD) respiratory failure with the control window of pulmonary infection as the switching point. Methods Forty patients diagnosed as COPD with respiratory failure requiring mechanical ventilation were enrolled in this study. Anti-infective and comprehensive treatment, when the control window of pulmonary infection, were randomly divided into invasive noninvasive sequential treatment group (sequential group) and conventional treatment group (control group). Patients in the sequential group underwent non-invasive mechanical ventilation with extubation, BiPAP ventilator with non-invasive mechanical ventilation, and control group with conventional invasive mechanical ventilation. The general condition, arterial blood gas analysis index, hospitalization time, mechanical ventilation time, ventilator-associated pneumonia (VAP) and mortality were observed. Results There was no significant difference between the sequential group and the control group before treatment (all P> 0.05). No significant difference was found in the circulatory and respiratory indices between the sequential group and the pre-extubation 3 h after non-invasive mechanical ventilation (all P> 0.05). The duration of invasive mechanical ventilation was (7.3 ± 3.0) days and (23.2 ± 16.1) days in sequential group and control group, respectively. The total duration of mechanical ventilation was (13.6 ± 8.2) days and (23.2 ± 16.1) days, (14.8 ± 5.6) days and (25.7 ± 7.8) days respectively. The incidence of VAP was 9.52% and 52.63% respectively. There was significant difference between the two groups (all P <0.05). Mortality rates were 4.76% and 5.26%, respectively, with no significant difference between the two groups (P> 0.05). Conclusions Taking the control window of lung infection as the switch point, using invasive noninvasive and sequential mechanical ventilation to treat COPD patients with respiratory failure can shorten the duration of invasive mechanical ventilation and hospital stay and reduce the incidence of VAP.