机械通气对慢性阻塞性肺疾病呼吸衰竭干预的临床研究

Clinical study on the intervention of respiratory failure due to chronic obstructive pulmonary disease by mechanic ventilation.

目的探讨机械通气在治疗慢性阻塞性肺疾病(COPD)急性加重期并呼吸衰竭的临床合理性及实用性。方法选择60例COPD急性加重期合并呼吸衰竭的患者,随机分为A组(NIPPV组)和B组(临床对照组),在综合治疗的前提下,A组采用提早的无创通气治疗,B组在鼻导管吸氧不能改善且病情恶化后使用有创通气,观察两组患者治疗前(0h)、治疗后2h、48h、出院时动脉血气结果、呼吸频率、心率、呼吸困难分级、辅助呼吸肌动用评分、气管插管率、呼吸机相关性肺炎发生率、死亡率、住院时间、住院费用各指标的变化。结果 NIPPV组与临床对照组治疗后2h、48h比较PaO_2差异有显著性(P<0．01),A组与0h相比,2h、48h患者的RR、HR、PaCo_2和SAARM均明显下降(P<0．05；P<0．01),而PaO_2明显上升(P<0．01),B组48h以上各指标下降的不明显,PaO_2只轻度升高,且气管插管率、vAP及死亡率均较高,也带来长的住院日和高的住院费用。结论对于COPD急性加重期并呼吸衰竭的惠者提早进行NIPPV,可以迅速改善缺氧,缓解呼吸困难,改善呼吸肌疲劳,减少插管率、死亡率、缩短住院时间。

Objective To investigate the clinic significance using invasive and noninvasive positive pressure ventilation （NIPPV） mechanical ventilation on acute exacerbation of chronic obstructive pulmonary disease（COPD） with respiratory failure. Methods A total of 60 patients suffering from respiratory failure due to acute exacerbation of COPD were randomly divided into group A（ NIPPV plus routine therapy） and group B（ routine therapy）. Blood gases, respiratory rates, heart rates, dyspnea scores, scores of the activity of accessory respiratory muscles, intubation rate, the incidence of ventilation associated pneumonia（ VAP）, mortality, duration of hospitalization, and cost of hospitalization（CH） were observed in all participants at 0h, 2h, 48h after therapy. Results There was significant difference in arterial partial pressure of oxygen （PaO2） at 2h and 48h after therapy between the NIPPV group and the control group （P 〈 0.01 ）. Respiratory rates, heart rates, arterial partial pressure of carbon dioxide（PaCO2） and the scores of the activity of accessory respiratory muscles were only significantly decreased （P 〈 0.05;P 〈 0.01） in the NIPPV group at 2 and 48h after therapy. The intubation rates, VAP rates,mortallty and CH in group B were all higher as compared with group A. Conclusion Early use of NIPPV can improve hypoxia and dyspnea, relieve the respiratory muscle fatigue, decrease the need for intubation, fatality and shorten the duration of hospitalization in patients with acute exacerbation of COPD with respiratory failure.