采用无创通气治疗慢性阻塞性肺疾病急性加重期临床观察

Clinical observation of noninvasive ventilation in the treatment of patients with acute exacerbations of chronic obstructive pulmonary disease

目的 观察无创通气（NIPPV）治疗急性加重期慢性阻塞性肺疾病（AECOPD）的临床效果.方法 将68例AECOPD合并Ⅱ型呼吸衰竭患者按数字表法随机分为两组：对照组予常规治疗,治疗组在常规治疗的基础上加用无创通气（BiPAP）治疗,比较两组血气分析（pH值、PaO2、PaCO2）、心率、呼吸频率,出院时统计患者住院时间、插管率及病死率.结果 两组治疗前均有CO2潴留、低氧血症、pH值下降,差异无统计学意义（均P ＞0.05）；治疗后治疗组血气分析（pH值、PaO2、PaCO2）及呼吸频率、心率改善均较对照组明显,差异有统计学意义（均P＜0.05）；观察组住院时间明显短于对照组（P＜0.05）；插管率明显低于对照组（P＜0.05）,观察组病死率稍低于对照组,但差异无统计学意义（P＞0.05）.结论 NIPPV治疗AECOPD能够明显改善血气分析指标、降低插管率、缩短住院时间.

Objective To investigate the therapeutic effect of non-invasive positi e pressure ventilation （NIPPV） in the treatment of patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD）.Methods 68 AECOPD patients with type Ⅱ repiratory failure were randomly divided into control group and treatment group.The control group was treated by conventional therapy alone and the treatment group was given conventional therapy combined with NIPPV.The levels of power of hydrogen （pH）,partial pressure of carbon dioxide in artery（PaCO2）,arterial oxygen tension（PaO2）,heart rate and repiratory rate were compared between the two groups.The mean length of patient stay,the frequency of tracheal intubation and the hospital mortality were analyzed after discharge from the hospital.Results Before treatment,the arterial blood gas analysis showed that the pH,PaCO2 and PaO2 had no significant differences between the two groups（all P ＞ 0.05）.After treatment,compared with the control group,the levels of pH,PaCO2 and PaO2 were obviously improved（all P ＜0.05）.The mean length of patients stay in the treatment group was significantly shorter than the control group（P ＜ 0.05）.The frequency of tracheal intubation of the treatment group was significantly lower than the control group（P ＜ 0.05）.The hospital mortality was lower in the treatment group,but the difference between the two groups was not significant （P ＞ 0.05）.Conclusion NIPPV for treating the AECOPD can improve the arterial blood gas analysis,decrease the need of tracheal intubation and shorten hospitalization time.