306例呼吸衰竭无创正压通气应用价值分析

Benefits of non-invasive positive pressure ventilation in 306 cases of respiratory failure

目的分析无创正压机械通气(NIPPV)在各种原因所致的呼吸衰竭治疗中的应用价值.方法采用经口鼻面罩双水平正压通气,吸气峰压为12～28 cmH2O,平均14.6±5.9cmH2O;呼气末压4～8cmH2O,平均4.2±0.9cmH2O.NIPPV无效者改为有创通气.分析指标包括:临床症状和动脉血气改善情况,以及BiPAP通气机使用和费用情况.根据动脉血气和临床症状的改善情况进行疗效评价.结果①NIPPV总有效率为79.7%.有效率因不同病种而异.由高到低依次排列为:COPD>支气管哮喘>肺结核>其他>肺炎>ILD>肺癌.其中最高为COPD,达92.7%,最低为肺癌,仅为56.7%.每日通气时间:2～19小时不等,平均6.35±2.31小时.用机天数1～52天,平均7.65±3.04天.NIPPV费用占总费用的4.72%,因病种不同而异,以COPD最高,占总费用的7.94%.②NIPPV有效者,上机前动脉血气状况明显好于无效病例.多次住院患者随NIPPV前血气改变的减轻,上机天数、住院天数和总费用也相应减少.③NIPPV无效病例以肺癌和ILD所占比例为高.主要与基础病变严重、病情危重有关.④62例NIPPV无效者中,28例改为有创通气,成功率为3.6%;而总费用却比单用NIPPV者高出1倍以上(2.06/1).结论①NIPPV适用于各种病因所致的,各种类型的,以及不同严重程度的呼吸衰竭的治疗.②早期上机有利于提高治疗成功率.

Objective To retrospectively evaluate （January 1997 to April 2002） benefits of noninvasive positive pressure ventilation （NIPPV） on the patients with respiratory failure. Methods 306 patients （227 males and 79 females,mean age 48.2 （14.57 yrs. ） with respiratory failure received NIPPV via full face-mask were enrolled in the study. Primary diseases： 123 （40.90%） cases of chronic obstructive pulmonary disease （COPD）, 60 （19.61%） of lung cancer, 53 （17.32%） of other diseases including bronchiectasis,interstitial lung disease （ILD）, pneumonia, tuberculosis and asthma. NIPPV was used in all patients： 12-28 cmH2O（14. 60±5. 90） of inspiratory peak airway pressure （IPAP） and 4-8 cmH2O （4.2±0.90） of expiratory peak airway pressure （EPAP） were delivered. Invasive positive pressure ventilation was delivered when NIPPV failed. Improvement of the patients＇ clinical status, changes of artery blood gases, ventilator application and cost were observed. Benefits of NIPPV were evaluated based on the improvement of artery blood gases and clinical symptoms. Results ①The total effective power was 79.70%. The effective powers were changing with primary diseases as follow： COPD （92.70%）, asthma （88.90%）, lung tuberculosis （ 81.80% ）, others （79.20%, maior including bronchiectasis）, pneumonia （ 78.9% ）, ILD （65.0%）,lung cancer （56.70%）. The daily use of NIPPV was from 2 to 19 hrs/day （6.35±2.31）. Duration of NIPPV 1-52 days （7.65±3.04）. The average cost of NIPPV was 4.72% of total,the highest was COPD and it reached 7.94%. ②NIPPV benefited patients were shown to produce significant improvements in arterial blood gases, reduced duration of hospitalization and decreased cost. ③Lung cancer and ILD were two of the most important primary diseases contributing to NIPPV failed patients,irreversible pulmonary destroys and severity of primary disease played a role in failed patients. 4.28 cases out of 62 NIPPV failed patients received invasive positive pressure ventilation, and the outcomes were very poor, the effective power was only 3.60% ,but the total cost increased to as twice as NIPPV benefited cases （2. 06/1）.Conclusions ①NIPPV is benefit to different type,severity and causes of respiratory failure. ②Early use of NIPPV improves effective power.