west china medical publishers
Keyword
  • Title
  • Author
  • Keyword
  • Abstract
Advance search
Advance search

Search

find Keyword "肺部感染控制窗" 2 results
  • 有创-无创序贯机械通气治疗COPD急性加重

    目的 评价有创-无创序贯机械通气治疗COPD 急性加重( AECOPD) 的临床疗效。方法 选择ICU 收治的AECOPD 患者13 例为序贯组, 同样病情患者12 例为对照组。临床出现“肺部感染控制窗”后, 序贯组拔除气管插管, 应用口鼻面罩双水平正压通气直至脱机; 对照组继续有创机械通气, 以压力支持方式脱机。比较两组患者机械通气时间、住院时间、呼吸机相关性肺炎( VAP)患病率和患者转归。结果 与对照组比较, 序贯组有创机械通气时间显著缩短[ ( 4. 33 ±1. 05) d 比( 10. 13 ±2. 06) d, P lt; 0. 001] , ICU 住院时间显著缩短[ ( 8. 79 ±2. 07) d 比( 11. 96 ±2. 11) d, P lt;0. 005] , VAP 发生数显著减少[ 0 比6 例, P lt;0. 01] 。总机械通气时间、总住院时间、再插管率和病死率均无显著性差异( P gt; 0. 05) 。结论 对需要机械通气的AECOPD 患者, 采用有创-无创序贯机械通气治疗, 可以缩短有创机械通气时间和ICU住院时间, 降低VAP 患病率。

    Release date:2016-09-14 11:23 Export PDF Favorites Scan
  • Invasive high-flow oxygen therapy and invasive-noninvasive ventilation sequential strategies for chronic obstructive pulmonary disease patients with severe respiratory failure: a randomized controlled trial

    ObjectiveTo compare the therapeutic effects of invasive-high-flow oxygen therapy (HFNC) and invasive-non-invasive ventilation (NIV) sequential strategies on severe respiratory failure caused by chronic obstructive pulmonary disease (COPD), and explore the feasibility of HFNC after extubation from invasive ventilation for COPD patients with severe respiratory failure.MethodsFrom October 2017 to October 2019, COPD patients with type Ⅱ respiratory failure who received invasive ventilation were randomly assigned to a HFNC group and a NIV group at 1: 1 in intensive care unit (ICU), when pulmonary infection control window appeared after treatments. The patients in the HFNC group received HFNC, while the patients in the NIV group received NIV after extubation. The primary endpoint was treatment failure rate. The secondary endpoints were blood gas analysis and vital signs at 1 hour, 24 hours, and 48 hours after extubation, total respiratory support time after extubation, daily airway care interventions, comfort scores, and incidence of nasal and facial skin lesions, ICU length of stay, total length of stay and 28-day mortality after extubation.ResultsOne hundred and twelve patients were randomly assigned to the HFNC group and the NIV group. After secondary exclusion, 53 patients and 52 patients in the HFNC group and the NIV group were included in the analysis respectively. The treatment failure rate in the HFNC group was 22.6%, which was lower than the 28.8% in the NIV group. The risk difference of the failure rate between the two groups was –6.2% (95%CI –22.47 - 10.43, P=0.509), which was significantly lower than the non-inferior effect of 9%. Analysis of the causes of treatment failure showed that treatment intolerance in the HFNC group was significantly lower than that in the NIV group, with a risk difference of –38.4% (95%CI –62.5 - –3.6, P=0.043). One hour after extubation, the respiratory rate of both groups increased higher than the baseline level before extubation (P<0.05). 24 hours after extubation, the respiratory rate in the HFNC group decreased to the baseline level, but the respiratory rate in the NIV group was still higher than the baseline level, and the respiratory rate in the HFNC group was lower than that in the NIV group [(19.1±3.8) vs. (21.7±4.5) times per minute, P<0.05]. 48 hours after extubation, the respiratory rates in the two groups were not significantly different from their baseline levels. The average daily airway care intervention in the NIV group was 9 (5 - 12) times, which was significantly higher than the 5 (4 - 7) times in the HFNC group (P=0.006). The comfort score of the HFNC group was significantly higher than that of the NIV group (8.6±3.2 vs. 5.7±2.8, P= 0.022), while the incidence of nasal and facial skin lesions in the HFNC group was significantly lower than that in the NIV group (0 vs. 9.6%, P=0.027). There was no significant difference in dyspnea score, length of stay and 28-day mortality between the two groups.ConclusionsThe efficacy of invasive-HFNC sequential treatment on COPD with severe respiratory failure is not inferior to that of invasive-NIV sequential strategy. The two groups have similar treatment failure rates, and HFNC has better comfort and treatment tolerance.

    Release date:2021-06-30 03:41 Export PDF Favorites Scan
1 pages Previous 1 Next

Format

Content