目的:研究有创-无创序贯性通气在急性呼吸窘迫综合征(ARDS)患者撤机中的应用和时机选择.方法: 随机将38例ARDS患者分成有创-无创序贯通气治疗组(A组)和常规有创通气治疗组(B组).A组由有创通气过渡到无创通气后撤机拔管,而B组则有创通气直至撤机拔管,比较两组呼吸机相关性肺炎(VAP)发生率、病死率、总机械通气时间和入住重症监护病房(ICU)的时间.结果: A组与B组VAP发生率分别为10.5%和78.9%例(P<0.05);病死率分别为21.1%和57.9%(P <0.05);总机械通气时间分别为(12±5)天和(22±11)天(P <0.05);住ICU时间分别为(15±7)天和(27±12)天(P <0.05).结论: ARDS机械通气患者当出现ARDS控制窗时改用无创通气可以降低VAP发生率,缩短机械通气和住ICU时间,降低病死率.
Objective: To evaluate the effect and the optimal t ime for extubation and sequential noninvasive ventilation (NIV) in patients with ARDS who received invasive ventilation. Methods: Thirty eight p atients with ARDS who received endotracheal invasive ventilation were randomly a ssigned to apply immediately NIV after extubation (A group) and to continue inva sive ventilation (B group) at the time ARDS control window had appeared. The inc idence of ventilator-associated pneumonia (VAP), the mortality rate, duration o f total mechanical ventilation and intensive care unit (ICU) stay were compared between A group and B group. Results:The incidence of VAP (10.5 %) and the mortality rate (21.1%) in A group patients were significantly lowe r than those (78.9% and 57.9%, P<0.05,respectively) in B group patients . In A group patients, those with early extubation following NIV had the duratio n of total mechanical ventilation of (12±5)days and ICU stay of (15±7)days which were shorter than those of B group patients, who continued invasive venti lation until met weaning criteria (22±11)days and (27±12)days, P<0.05, respectively). Conclusion: At the time ARDS control window had ap peared, patients received invasive ventilation who were extubated promptly and a pply NIV immediately may decrease the incidence of VAP and mortality rate, short en duration of total mechanical ventilation and ICU stay. [
Journal of Jiangsu University Medicine Edition
Acute Respiratory Distress Syndrome
Invasive vent ilation