Zheng Da-Wei, Wang Cheng-Zhi, Liu Ren-Shui, Gao Feng, Deng Shun-Lian, Zhou Peng, He Yan
Intensive Care Unit, Huaihua Second People's Hospital, Huaihua 418000, Hunan, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011 Apr;23(4):224-7.
To estimate the feasibility and the efficacy of early extubation and the sequential non invasive mechanical ventilation (MV) in severe respiratory failure of chronic obstructive pulmonary disease (COPD) with the improved Glasgow coma scale (GCS) score of 15 as the switching point.
By a prospective control study, 20 patients with COPD and respiratory failure who had undergone endotracheal intubation and MV from March 2007 to November 2009 were enrolled as treatment group. Invasive MV with synchronous intermittent mandatory ventilation and pressure support ventilation (SIMV+PSV) pattern were given to these patients. When the period of "improved GCS score of 15 standard" window period appeared and being kept for 2 hours, endotracheal tube was extubated, and nasal mask with PSV+positive end expiratory pressure (PEEP) was used, followed by gradual decrease of the level of pressure support till weaning of MV. Nineteen patients who were treated with MV with ordinary way of weaning from March 2005 to March 2007 served as the control group. Prior to the MV, the ventilation and oxygenation index , the length of invasive MV, total MV time, total hospital stay, re intubation and ventilator associated pneumonia (VAP) occurred in the number of cases were observed and compared between two groups.
There was no significant difference in the ventilation and oxygenation index prior to the MV. Compared with control group, in treatment group, the length of invasive ventilation (days: 3.2±1.1 vs. 10.5±3.2), the total duration of MV (days: 4.8±2.5 vs. 10.5±3.2), the length of hospital stay (days: 17±3 vs. 22±7) were significantly shorter (all P<0.01), and the incidence of VAP was significantly lower (cases: 0 vs. 5, P<0.01), while the number of re intubation was slightly higher but without statistical significance (cases: 3 vs. 1, P>0.05).
The application of improved GCS score of 15 as the switching point with 2 hours as window period for early extubation and non invasive nasal mask ventilation can significantly improve the therapeutic effect in patients with severe respiratory failure in COPD.
以格拉斯哥昏迷量表（GCS）评分改善至15分为切换点，评估早期拔管及序贯无创机械通气在慢性阻塞性肺疾病（COPD）严重呼吸衰竭中的可行性及疗效。
采用前瞻性对照研究，选取2007年3月至2009年11月期间行气管插管及机械通气的COPD呼吸衰竭患者作为治疗组。对这些患者采用同步间歇指令通气和压力支持通气（SIMV+PSV）模式进行有创机械通气。当出现“GCS评分改善至15分标准”的窗口期并持续2小时后，进行气管插管拔管，使用带PSV+呼气末正压（PEEP）的鼻面罩，随后逐渐降低压力支持水平直至机械通气撤离。选取2005年3月至2007年3月期间采用常规撤机方式进行机械通气的19例患者作为对照组。观察并比较两组患者机械通气前的通气及氧合指数、有创机械通气时间、总机械通气时间、总住院时间、再次插管情况及呼吸机相关性肺炎（VAP）发生例数。
两组患者机械通气前的通气及氧合指数无显著差异。与对照组相比，治疗组的有创通气时间（天：3.2±1.1 vs. 10.5±3.2）、总机械通气时间（天：4.8±2.5 vs. 10.5±3.2）、住院时间（天：17±3 vs. 22±7）均显著缩短（均P<0.01），VAP发生率显著降低（例数：0 vs. 5，P<0.01），而再次插管例数略高但无统计学意义（例数：3 vs. 1，P>0.05）。
以GCS评分改善至15分为切换点，2小时为窗口期进行早期拔管及无创鼻面罩通气，可显著提高COPD严重呼吸衰竭患者的治疗效果。
