无创正压通气和有创正压通气在治疗COPD急性加重并严重呼吸衰竭患者中的比效

Comparison of no-invasive positive pressure ventilation with invasive positive pressure ventilation in treating patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and severe respiratory failure

目的本研究探讨无创正压通气与有创正压通气治疗COPD急性加重并严重呼吸衰竭患者的疗效。方法选择34例次COPD急性加重并严重呼吸衰竭患者,随机分成2组,每组17例次。无创通气组予常规治疗联合使用无创通气,有创通气组予常规治疗联合使用有创通气治疗,动态观察两组病例血气分析,记录医院获得性肺炎、住院费用和住院时间等的差异。结果(1)两组均可明显改善血气,有创通气组的入院后2日血气改善明显优于无创通气组(P<0.01);(2)两组均可明显改善APACHEⅡ评分,有创通气组的入院后2日的APACHEⅡ评分小于无创通气组(P<0.01);(3)无创通气组的住院费用和医院获得性肺炎发生率低于有创通气组(P<0.01)。结论无创有创正压通气均可改善COPD急性加重并严重呼吸衰竭患者的病情,无创通气可减少住院费用和医院获得性肺炎发生率。

objective To investigate the difference of no-invasove positve pressure ventilation（NPPV） and invasive positive pressure ventilation in treating patients with acute exacerbation of chronic obstructive pulmonary disease （COPD） and severe respiratory failure. Methods 34 patients with acute exacerbation of chronic obstructive pulmonary disease （COPD） and severe respiratory failure were randomly divided into two groups. The patients in invasive ventilation group were given invasive positive pressure ventilation and routine treatment： the patients in NPPV group were administered noninvasive positive pressure ventilation in addition to routine treatment. The blood gases, APACHE Ⅱ score , the rate of hospital aquired pneumonia ,days of hospitalization and costs of hospitalization were observed in the research. Results （1）Two groups can improve the blood gases, the improvemen; in the blood gases was more in invasive ventilation group than NPPV group＇s two days after hospitalization （P〈0. 01）; （2） Two groups can improve the APACHE Ⅱ score, the APACHEⅡscore in invasive ventilation group was lower than NPPV group＇s two days after hospitalization （P〈0. 01）; （3） The rate of hospital aquired pneumonia and in NPPV group was lower than invasive ventilation group＇s （P〈0. 01）. Conclusion NPPV and invasive positive pressure ventilation can improve the patient＇s condition in patients with acute exacerbation of COPD and severe respiratory failure. NPPV can reduce the rate of hospital aquired pneumonia and costs of hospitalization.