余荣环  黄运平  陈弘群  胡斌  黄莺  徐敏

　　上海市徐汇区中心医院呼吸内科（上海  200031）

　　[摘要]  目的  探讨有创与无创序贯机械通气（简称序贯性机械通气）抢救非COPD病因所致严重呼吸衰竭的临床效果及应用价值。方法  选择非COPD病因所致呼吸衰竭患者18例为非COPD组，COPD所致呼吸衰竭15例为COPD组。先经口气管插管正压通气，根据病情在3～7天内拔除气管插管改为无创正压通气。观察两组病例的血气分析指标、机械通气时间、呼吸机相关性肺炎发生例数、撤机成功例数、住院死亡例数等。结果  非COPD组和COPD组治疗前基础情况匹配良好（P均＞0.05）。非COPD组有创通气时间明显长于COPD组（P＜0.05），总通气时间、撤机成功例数、住院死亡例数两组均无显著性差异（P＞0.05），住院费用明显高于COPD组（P＜0.05）。结论  序贯性机械通气策略对重症肺炎急性心源性肺水肿等非COPD病因所致呼吸衰竭可能也具有一定优势。上海徐汇区中心医院呼吸内科余荣环

　　[关键词]  呼吸衰竭；机械通气；无创正压通气；慢性阻塞性肺疾病

　　Application of sequential invasive to noninvasive mechanical ventilation in treatment of severe respiratory failure  YU Rong-huan,HUANG Yun-ping,CHEN Hong-qun， HU Bin, HUANG Ying, XU Min. Department of Respiratory Medicine, Xuhui District Central Hospital, Shanghai, 200031,China

　　Corresponding author:YU Rong-huan,E-mail:yurhxh@yahoo.com.cn

　　[Abstract]  Objective  To evaluate the efficacy of early extubation and sequential invasive to noninvasive mechanical ventilation(MV) in treatment of severe respiratory failure. Methods  25 patients with severe respiratory failure due to different causes were involved in the sequential therapy group. After 3-7 days intubation and invasive positive pressure MV, the extubation was conducted and followed by noninvasive MV. Other 23 cases with similar clinic characteristics who continuously received invasive MV were assigned to control group. Compare the markers of blood gas analysis, the duration of MV, the incidence of ventilator-associated pneumonia, the incidence of death. Results  There were no significant differences in the clinical characteristics between the two groups（P>0.05）.The patients in the sequential therapy group showed less invasive MV duration, incidence of ventilation associate pneumonia, the mortality rate and hospitalization cost compared to control subjects（P0.05

　　二、两组有关医疗指标比较

　　见表2。非COPD组有创通气时间明显长于COPD组（P0.05），住院费用非COPD组明显高于COPD组（P0.05         >0.05