中国全科医学2018，Vol.21Issue(2)：140-144,5.DOI:10.3969/j.issn.1007-9572.2018.02.05
基于改良格拉斯哥昏迷量表的慢性阻塞性肺疾病合并呼吸衰竭患者有创-无创序贯通气切换点研究
The Switching Point for Sequential Invasive to Noninvasive Ventilation in Patients with Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure based on the Improved Glasgow Coma Scale
摘要
Abstract
Objective To compare the therapeutic efficacy of improved Glasgow Coma Scale scores of≥ 13 and 15 as the switching points for sequential invasive to noninvasive ventilation for the treatment of patients with chronic obstructive pulmonary disease(COPD) complicated with respiratory failure.Methods We enrolled 100 COPD patients complicated with respiratory failure,subjected to tracheal intubation and mechanical ventilation at the EICU,the Affiliated Wenling Hospital of Wenzhou Medical University,from March 2015 to March 2017.The patients were randomly divided into two groups(groups A and B) using a random number table,with 50 subjects in each group.All patients in groups A and B received invasive mechanical ventilation,and sequential noninvasive mechanical ventilation after the improved Glasgow Coma Scale score was kept stable at≥ 13 or 15 for 3 h.The mean arterial pressure,oxygenation index,arterial partial pressure of oxygen(PaO2),and arterial partial pressure of carbon dioxide(PaCO2) were measured before extubation and 3 h after noninvasive mechanical ventilation. The duration of invasive mechanical ventilation,incidence of re-intubation,incidence of ventilator-associated pneumonia,and total hospital stay were recorded.Results There were no significant differences in the mean arterial pressure,oxygenation index,PaO2,or PaCO2 between groups A and B before extubation and 3 h after noninvasive mechanical ventilation(P>0.05). Furthermore,no significant differences were found in the mean arterial pressure,oxygenation index,PaO2,or PaCO2 between before extubation and 3 h after noninvasive mechanical ventilation in the two groups(P>0.05).In addition,the incidence of re-intubation did not significantly differ between groups A and B(P>0.05).However,a significantly shorter duration of invasive mechanical ventilation and total hospital stay and a lower incidence of ventilator-associated pneumonia were found in group A compared to group B(P<0.05).Conclusion The use of an improved Glasgow Coma Scale score of≥ 13 as the switching point for sequential invasive to noninvasive ventilation may shorten the duration of invasive mechanical ventilation and total hospital stay and reduce the incidence of ventilator-associated pneumonia in the treatment of COPD patients complicated with respiratory failure.关键词
呼吸衰竭/肺疾病,慢性阻塞性/通气,机械/撤机/格拉斯哥昏迷量表Key words
Respiratory failure/Pulmonary disease/chronic obstructive/Ventilation/mechanical/Extubation/Glasgow Coma Scale分类
医药卫生引用本文复制引用
张近波,张丽红,朱金强,吴仙丹,洪金晶,潘佩佩..基于改良格拉斯哥昏迷量表的慢性阻塞性肺疾病合并呼吸衰竭患者有创-无创序贯通气切换点研究[J].中国全科医学,2018,21(2):140-144,5.基金项目
温岭市科技局课题(2014C31BA0032) （2014C31BA0032）
