慢性阻塞型肺疾病伴Ⅱ型呼吸衰竭患者实施无创通气最佳时机的探讨

Optimal time of the use of noninvasive positive pressure ventilation in the patients with Ⅱ respiratory failure and chronic obstructive pulmonary disease

目的探讨无创通气(NIPPV)用于治疗慢性阻塞性肺疾病(COPD)伴Ⅱ型呼吸衰竭患者的最佳时机。方法120例COPD患者随机分为NIPPV组和常规治疗组(对照组),在治疗前及治疗2 h、第3天观察两组血气、临床症状、肺功能和预后的变化。根据病情将患者分为轻、中、重三组,评价NIPPV的效果,选择应用NIPPV的最佳时机。结果NIPPV组在治疗2h后迅速改善了患者的心率、呼吸频率、呼吸困难评分、辅助呼吸肌动用评分和血气(P<0.05)。实施NIPPV后,患者的住院时间由20.6±28.9 d缩短至12.4±9.9 d,插管率由26.7%降至11.7%,病死率由13.3%降至3.3%(P<0.05)。轻、中度患者实施NIPPV的成功率较高,而重度患者的疗效不佳。结论COPD伴Ⅱ型呼吸衰竭患者应尽早使用NIPPV,应用NIPPV的最佳时机为50 mmHg<PaCO2≤90 mmHg,40 mmHg≤PaO2<60 mmHg。

Objective To evaluate the optimal time of the ase of nnninvasive positive pressure ventilation （ NIPPV） in the patients with Ⅱ respiratnry failure and chronic obstructive pulhmontary disease （COPD）. Methods 120 patients were divided at random NIPPV group and conventional therapy group （control group）. Clinical symptoms, arterial blood gases, pulmonary functions and clinical ouleomes were measured before and after treatment. Patients were again divided into mild, moderate and severe group tn detemine the optimal time of NIPPV. Results Heart rate, respiratnry rate, dysp,ea score, scale for accessuty muscle use and arterial blood gases were improved rapidly at 2 h after treatment in NIPPV group （ P 〈 0. 05） . The use of NIPPV reduced the duratinn of hospital （from 20.6 ± 28.9 d to 12.4 ± 9.9 d, P 〈 0.05）, the rate of intubation （from 26.7% to 11.7% ）, the hospital mortality （ form 13.3% to 3.3%, P 〈 0.05）. NIPPV was succeeded in mild and mnderate group but failed in severe group. Conclusion NIPPV shonhl be used earlier in the patients with Ⅱ respiratory failure and COPD. The optimal time was 50 mmHg 〈 PaCO2≤ 90 mmHg, 40 mmHg≤ PaO2 〈 60 mmHg.