无创正压通气在治疗慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭中的应用

A clinical analysis on treatment of patients who suffered from acute exacerbations of chronic obstructive pulmonary disease with typeⅡrespiratory failure

目的研究元创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)急性加重期并发Ⅱ型呼吸衰竭的临床效果。方法选择2001年1月至2005年5月我院呼吸内科46例NIPPV治疗COPD急性加重期并发Ⅱ型呼吸衰竭患者的血气指标变化(pH值,PaO2,PaCO2),住院病程,气管插管率和病死率,并同以往未使用NIPPV治疗的50例COPD相似病例进行比较分析。结果46例NIPPV前后24 h血气指标明显改善,住院病程缩短,气管插管率和住院病死率明显降低,同非NIPPV治疗的对照组比较差异有统计学意义。NIPPV组中,重度呼吸衰竭的气管插管率明显高于轻度呼吸衰竭(P<0．05)。结论NIPPV是治疗慢性阻塞性肺疾病急性加重期并发Ⅱ型呼吸衰竭的一种有效方法,早期应用可能阻止病情进一步发展,缩短病程。

Objective To study the effect of noninvasive pressure venrilation（NIPPV） on the treatment acute exacerbarions of chronic obstructive pulmonary disease（COPD） with type Ⅱ respiratory failure. Methods of 46 cases of COPD were selected to treat with NIPPV in our hospital from 2001 January to 2005 May. The data in arterial blood gas（pH, PaOz,PaCOz）,the course of disease in the hospital, the rate of endotracheal intubation, the mortality of the patients in NIPPV were analyzed and compared with those of the patients without NIPPV treatment before. Results The datas in arterial blood gas had been imprived significantly in NIPPV after 24h. The couse of disease in hospital was significantly shkrter, and the rate of endotracheal intubation and mortality of the patients was significantly lower in NIPPV than those in no NIPPV. There was remarkably difference between two groups. In NIPPV,the rate of endotracheal intubation were significantly lower in light and moderate trspiratkry failure than those in severe respiratory failure（P 〈 0.05）. Conclusion N IPPV is an effective method in the treatment of acute exacerbations of COPD with type Ⅱ respiratory failure. NIPPV can delay the course of disease if it is applied in early stage.