无创正压通气在慢性阻塞性肺疾病合并肺性脑病时的临床应用

Clinical application of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease complicated with pulmonary encephalopathy

目的观察慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺性脑病患者在常规治疗基础上应用无创正压通气(noninvasive positive pressure vventilation,NIPPV)治疗的效果。方法将符合COPD合并肺性脑病50例患者,随机分为两组:常规治疗组;NIPPV组:在常规综合治疗基础上,应用NIPPV治疗,监测血气分析、心率、神态、血压等变化,分析结果。结果与治疗前比较,NIPPV组治疗后24h内22例患者神志转清,3例需改用有创通气,治疗后1￣6hPH、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)变化与治疗前有显著性意义(P<0.05)。而常规组治疗后1￣6h动脉血气及心率均无明显变化(P>0.05)。NIPPV组治疗失败率明显低于常规组,平均住院时间明显短于常规治疗组。结论无创正压道气治疗COPD合并肺性脑病患者具有明确疗效,值得临床推广。

[Objective] To observe the clinical effects of noninvasive positive pressure ventilation （NIPPV） for patients with chronic obstructive pulmonary disease （COPD） complicated with pulmonary encephalopathy.[Methods] 50 patients with COPD complicated with puhnonary encephalopathy were randomly divided to receive conventional therapy （conventional therapy group） or NIPPV with the conventional therapy （NIPPV group）. NIPPV was delivered to patients by a face mask. Arterial blood gases, heart rate, and blood pressure. [Results] In NIPPV group, there was a significant improvement of pH and PaO2, PaCO2 in 1 and 6 hours after therapy, pH and PaO2,PaCO2 were improved obviously 6 hours after therapy compared with baseline （P 〈0.05）. In conventional therapy group, arterial blood gases, heart rate, and blood pressure showed no significant differences at 1 and 6 hours after therapy （P 〉0.05）. Failure rate of treatment was markedly lower and the average stay in hospital were shorter in the NIPPV group than that in the conventional therapy group. [Conclusion] NIPPV is an effective ventilatory pattern for patients with COPD complicated with pulmonary encephalopathy.