无创正压通气在肺性脑病的治疗价值及其局限性

Clinical values and limitations of using BIPAP ventilation in the treatment of pulmono-encephalopathy

目的 观察无创正压通气 (BIPAP)在肺性脑病中的治疗价值及其局限性。方法 5 6例肺性脑病患者经 BIPAP通气治疗为治疗组 ,同期 5 6例常规方法治疗为对照组 ,比较两组治疗前后血气分析指标及临床改善情况。结果 治疗组经无创正压治疗后临床症状改善和血气分析指标恢复正常 ,与对照组比较差异有显著性 (P<0 .0 1)。结论 BIPAP在肺性脑病治疗中疗效肯定。对有较严重的意识障碍和 (或 )严重感染、痰量多、粘稠且咳痰无力者 ,宜行有创通气。照组相比均有显著性差异 (P<0 .0 1)。见表 1、表 2。表 1 两组治疗前后临床症状改善比较组别例数 神志转清心率下降呼吸频率下降辅助呼吸肌动作减轻治疗组 5 6 5 0 5 0 5 0 5 0对照组 5 6 2 314 2 5 17 注 :均 P<0 .0 13 讨 论肺性脑病是一种病死率极高的常见病 ,降低其病死率除需有效的抗生素外 ,有赖于早期的有效的呼吸支持 ,虽然有创机械通气在 COPD并发肺性脑病中发挥着重要作用 ,但有创机械通气尚存在创伤大、人工气道管理困难、易出现机械通气相关肺损伤、肺感染及不易脱机等许多问题。因此 ,积极探索无创通气在 COPD并肺性脑病治疗中的价值有着极其重要意义。表 2 两组治疗前后血气分析结果比较 (X±s)组别 PH Pa O2 (k Pa) Pa CO2 (k Pa) Sa

Objective To observe the clinical values and the limitations of using non-invasive BIPAP ventilation in the treatment of pulmono-encephalopathy.Methods Fifty-six pulmono-encephalopathy patients were treated by non-invasive BIPAP ventilation (treatment group) and another 56 were treated by regular method (control group). The two groups were compared on blood gas parameters and on clinical improvements before and after the treatments.Results The treatment group had achieved normal blood gas values after the treatment and had significantly better improvement in blood gas analysis and in clincial symptoms than the control group (P < 0.01).Conclusion The treatment effects of using non-invasive BIPAP ventilation are obvious. It is of great value for those who have somewhat severe mental disorders or severe infections, or who have excessive mucinoid sputum which is difficult to spit out.