摘要：目的：探讨有创-无创机械通气序贯性脱机治疗重度慢性阻塞性肺病临床疗效，评价序贯性脱机的可行性。方法：19例重度慢性阻塞性肺病患者在采用有创-无创机械通气序贯性脱机治疗，16例重度慢性阻塞性肺病患者传统方式治疗，分析并比较两组患者机械通气前APACHEⅡ评分、 PaO2/FiO2、PaCO2、心率(HR)、平均动脉压(MAP)及接受有创机械通气时间、总机械通气时间、总住院时间、重新插管率、呼吸机相关肺炎(VAP)发生率。结果：有创-无创机械通气序贯性脱机治疗重度(COPD)疗效显著，序贯治疗组较对照组总机械通气时间差异无显著性，有创通气时间缩短(P<0.05)，重新插管率明显低于对照组(P<0.05)。各项呼吸、循环指标优于传统脱机方式治疗。结论：无创机械通气能够达到支持肺泡通气、改善并维持氧合、缓解呼吸肌疲劳的目的，可显著降低有创机械通气和总机械通气时间，减少呼吸机相关肺炎(VAP)的发生，使患者顺利脱机，减少重新插管。

     关键词：慢性阻塞性肺病;呼吸衰竭;机械通气

    The Clinical Observation in Severe COPD and Respiratory Failure by Using Sequential Non-invasive Mechanical Ventilation After Invasive Mechanical Ventilation

    DING Hong-hui,YU Tian-feng,et al

    (Shantou Central Hospital, Guangdong Shantou 515031, China)

    Abstract： Objective： To explore the clinical therapeutic effect and feasibility of sequential invasive and non-invasive mechanical ventilation in severe chronic obstructive pulmonary disease(COPD).Method: 19 patients with COPD underwent sequential invasive and non-invasive mechanical ventilation,and 16 patients with COPD underwent conventional treatment ,to analyse and compare the APACHEⅡ score , PaO2/FiO2、PaCO2, heart rate(HR),mean arterial and pressure invasive mechanical ventilation time ,total mechanical ventilation time,total length of stay and incidence rate of repeated tracheal intubation,the incidence rate of ventilator associated pneumonia(VAP).Result: Sequential invasive and non-invasive mechanical ventilation in severe chronic obstructive pulmonary disease(COPD) had significant therapeutic effect, there was no significant difference of total mechanical ventilation time between the two groups ,the total mechanical ventilation time of sequential invasive mechanical ventilation shortened (P<0.05)and the incidence rate of repeated tracheal intubation in sequential invasive and non-invasive mechanical ventilation was lower than conventional treatment(P<0.05),every index of respiration and circulation in sequential invasive mechanical ventilation were significantly improved compared with conventional treatment.Conclusion: Non-invasive mechanical ventilation can maintain the alveolar ventilation , improve the oxygenation and respiratory muscle fatigue, reduce invasive mechanical ventilation time and the incidence rate of total mechanical ventilation time and ventilator associated pneumonia(VAP),it can help the patients successfully remove the respirator and reduce the repeated tracheal intubation. ......