无创正压机械通气对慢性阻塞性肺疾病急性加重期呼吸衰竭的救治

Noninvasive positive pressure ventilation in severe respiratory failure of chronic obstructive pulmonary disease

目的进一步评价和认识无创正压机械通气在救治慢性阻塞性肺疾病(COPD)严重呼吸衰竭中的地位和作用。方法前瞻性研究了25例COPD急性加重期患者,均伴有严重的Ⅱ型呼吸衰竭(PaCO2>80mmHg),应用无创双水平正压通气治疗,监测血气、通气参数、临床转归等情况。结果无创机械通气治疗有效22例,治疗开始后1小时血气无明显改变,3小时PaCO2显著下降(P<0.05),pH值上升(P<0.05),病情改善。其中少数患者PaCO2>100mmgH、或伴有昏迷,无创通气抢救成功。患者对鼻面罩及正压通气接受性良好,副作用少。结论无创机械通气为抢救COPD合并呼吸衰竭提供了有效的手段。

Objective To further evaluate noninvasive positive pressure ventilation （NIPPV） in acute exacerbations of chronic obstructive pulmonary disease （COPD）. Methods 25 cases of sever respiratory failure due to COPD （PaCO2〉80mmHg） were prospectively investigated. Blood gas, ventilation parameters, clinic sings were monitored before, during and after continuous NIPPV. Results Successful outcome was gained in 22 cases underwent NIPPV. Blood gases did not significantly change at 1 hour after NIPPV,but significantly improved at 3 hour after NIPPV. 3cases failed and were intubated. All cases were tolerated to NIPPV and mask, and few complications were found. Conclusions NIPPV is an effective therapeusis in severe respiratory failure due to COPD.