摘要
目的探讨以改良格拉斯哥评分15分为切换点在行有创-无创序贯机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭患者中的应用效果。方法选择2007年3月～2010年2月入住本院的慢性阻塞性肺疾病致严重呼吸衰竭患者44例,随机分为治疗组和对照组。治疗组28例,采用以改良格拉斯哥评分15分为切换点行有创-无创序贯机械通气治疗。对照组16例,采用"肺部感染控制窗"为治疗切换点行有创-无创序贯性机械通气治疗。观察2组患者机械通气前通气及氧合指标、有创通气时间、总机械通气时间、住院时间、呼吸机相关性肺炎发生例数。结果治疗组和对照组有创通气时间分别为(3.2±1.4)d和(5.4±2.3)d(P<0.01);总机械通气时间分别为(4.8±2.3)d和(8.5±2.8)d(P<0.01);总住院时间分别为(17±4)d和(21±5)d(P<0.01);再插管例数分别为3例和2例(P>0.05);呼吸机相关性肺炎发生例数分别为0例和3例(P>0.05)。结论精心细致护理、准确把握治疗切换点是治疗成功的关键。
ObjectiveTo explore the effect of improved Glasgow Coma Scale（15 point） as switching point in invasive-noninvasive mechanical ventilation on patients with severe respiration failure caused by chronic obstructive pulmonary disease.Methods44 cases with chronic obstructive pulmonary admitted to hospital from Mar.2007 to Feb.2010 were randomly divided into two groups,treatment group with 28 cases and control group with 16 cases.The treatment group was treated with improved Glasgow Coma Scale（15 point） as switching point for invasive-noninvasive mechanical ventilation.The control group was treated with pulmonary infection control window as switching point for invasive-noninvasive mechanical ventilation.The ventilation and oxygenation index prior to mechanical ventilation,the time of invasive mechanical ventilation,the total time of mechanical ventilation,the total hospital stay,the re-intubation rate and the incidence cases of VAP were compared between the two groups.ResultsThe time of invasive mechanical ventilation for treatment group was（3.2±1.4）d,while the time for control group was（5.4±2.3）d（P0.01）;the total time of mechanical ventilation for treatment group was（4.8±2.3）d,while the time for control group was（8.5±2.8）d（P0.01）;the total hospital stay for treatment group was（17±4）d,while the time for control group was（21±5）d（P0.01）;the cases of re-intubation in treatment group were 3 cases,compared with 2 cases in control group（P0.05）;the cases of VAP in treatment group were 0,compared with 3 cases in control group（P0.05）.ConclusionCareful and meticulous care,accurately grasping the switching point are critical to successful treatment.
关键词
慢性阻塞性肺疾病
呼吸衰竭
机械通气
改良格拉斯哥评分
护理
Chronic Pulmonary Disease
Respiration Failure
Mechanical Ventilation
Improved Glasgow Coma Scale
Nursing
