重症慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者有创-无创呼吸机序贯治疗效果研究OA

Objective To explore the effect of invasive-noninvasive ventilator sequential therapy on patients with severe chronic obstructive pulmonary disease(COPD)complicated with typeⅡrespiratory failure and its influence on heart rate.Methods A retrospective analysis was conducted on the clinical data of 47 patients with severe COPD complicated with typeⅡrespiratory failure from March 2023 to June 2024.The patients were divided into two groups based on different treatment methods:23 cases in the control group were treated with invasive mechanical ventilation,and 24 cases in the observation group were treated with sequential invasive and non-invasive mechanical ventilation.The differences in clinical treatment indicators[respiratory intensive care unit(RICU)treatment,invasive ventilation,total mechanical ventilation and hospital length of stay],vital signs(respiratory rate,heart rate),blood gas indicators[arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),oxygenation index(PaO2/FiO2)],weaning success rate,incidence of ventilator-associated pneumonia(VAP)and in-hospital mortality were compared between the two groups.Results The treatment time in the RICU,the duration of invasive ventilation,the total mechanical ventilation time,and the hospital length of stay in the observation group were significantly shorter than those in the control group[lengths of RICU stay(days):9.38±7.17 vs.16.40±9.56,invasive ventilation time(days):5.74±3.85 vs.10.82±6.21,total mechanical ventilation time(days):10.25±5.70 vs.15.06±7.52,hospital length of stay(days):14.61±5.22 vs.21.78±7.23,all P<0.05];after treatment,the respiratory rate,heart rate,PaCO2,VAP incidence rate,and in-hospital mortality in the observation group were significantly lower than those in the control group[respiratory rate(breaths/min):21.05±3.96 vs.23.97±4.04,heart rate(beats/min):83.14±5.08 vs.89.38±5.25,PaCO2(mmHg,1 mmHg≈0.133 kPa):47.10±4.34 vs.60.57±4.20,VAP incidence rate:4.17%vs.26.09%,in-hospital mortality:0.00%vs.17.39%,all P<0.05];PaO2,PaO2/FiO2 and the success rate of weaning from mechanical ventilation were significantly higher than those in the control group[PaO2(mmHg):87.63±5.21 vs.78.22±5.25,PaO2/FiO2(mmHg):219.08±13.03 vs.195.55±13.13,success rate of weaning:87.50%vs.60.87%,all P<0.05].Conclusion Patients with severe COPD accompanied by typeⅡrespiratory failure who undergo sequential treatment with invasive and non-invasive ventilators can effectively accelerate recovery,improve their vital signs and blood gas parameters,increase the success rate of weaning from mechanical ventilation,and reduce the incidence of VAP and hospital mortality.