无创正压通气对慢性阻塞性肺疾病急性加重期合并呼吸衰竭的治疗作用

A randomized,prospective evaluation of non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease

目的探讨NPPV(无创正压通气)治疗慢性阻塞性肺疾病(COPD)急性加重期合并呼吸衰竭的治疗作用。方法将2002-12～2004-04大连医科大学附属第一医院呼吸内科住院的COPD急性加重期合并急性呼吸衰竭的患者42例随机分为标准治疗组21例(常规抗感染、支气管扩张剂、祛痰药、激素、氧疗、纠正酸碱失衡的治疗)和NPPV治疗组21例(标准治疗的治疗基础上,采用美国伟康公司经鼻(面)罩双水平气道正压BiPAPVERSION型呼吸机进行辅助通气)。观察患者PaO2、PaCO2变化,比较插管率、病死率、住院时间、住院费用。结果治疗2h后,NPPV治疗组和标准治疗组PaO2、PaCO2、呼吸频率均有明显改善,并且NPPV治疗组明显优于标准治疗组(P<0.05)。NPPV治疗组插管率、病死率、住院时间、住院费用较标准治疗组均明显降低(P<0.05)。结论NPPV可加速改善COPD急性加重期合并呼吸衰竭患者的PaO2、PaCO,可明显缩短住院时间及降低住院费用,降低插管率、病死率。

Objective To determine the efficacy of Non - invasive positive pressure ventilation （NPPV） in the management of patients with respiratory failure due to an acute exacerbation of chronic obstructive pulmonary disease （COPD）. Methods Forty - two patients were included in the study. Of them, 21 were randomly allocated to receive NPPV plus “standard care”and 21 to “standard care”. Both groups had similar characteristics upon their admission in the hospital. Results The use of NPPV significantly decreased the PaCO2 level and respiratory rates, but significantly increased the PaO2 level after 2 hours of treatment （P 〈 0. 05 ）. The NPPV significantly reduced the need for endotracheal intubation, the in - hospital mortality rate, the mean hospital stay and the costs （P 〈 0. 05 ）. Conclusion The results suggest that NPPV can improve the gas exchange, and non - invasive positive pressure ventilation is an effective ventilatory support in the patients with respiratory failure due to an acute exacerbation of COPD.