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目的评价无创正压通气(NPPV)作为慢性阻塞性肺疾病急性加重(AECOPD)有创通气患者撤机方式的应用效果。方法 74例AECOPD有创通气患者随机选择NPPV(拔管后立即应用NPPV过渡撤机)或常规低水平压力支持通气方式撤机。比较两组动脉血气变化、呼吸机相关性肺炎(VAP)的发生率、机械通气时间、住院时间、再插管率和病死率。结果两组患者总的机械通气时间、住院时间和再插管率相似。但NPPV撤机组有创通气时间明显缩短(P<0.01),VAP发生率和病死率均低于常规撤机组(P<0.05)。结论 NPPV用作AECOPD并呼吸衰竭患者的撤机方式,可明显缩短有创通气时间,降低VAP发生病和病死率,改善患者预后。
Objective To evaluate the effect of noninvasive positive pressure ventilation (NPPV) as weaning method in patients with invasive ventilatory disease of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Totally 74 patients with AECOPD invasive ventilation were randomly selected for NPPV (NPPV transitional extubation immediately after extubation) or conventional low-level supportive ventilation. The arterial blood gas changes, the incidence of ventilator-associated pneumonia (VAP), duration of mechanical ventilation, length of hospital stay, reintubation and mortality were compared between the two groups. Results The total duration of mechanical ventilation, length of stay, and reintubation were similar in both groups. However, the duration of invasive ventilation was significantly shorter in NPPV patients (P <0.01). The incidence of VAP and mortality in patients with NPPV were significantly lower than those in patients with conventional mechanical ventilation (P <0.05). Conclusions The use of NPPV as a weaning method in patients with AECOPD and respiratory failure can significantly shorten the duration of invasive ventilation, reduce the incidence and mortality of VAP, and improve the prognosis of patients.