双水平无创正压通气治疗慢性阻塞性肺疾病合并肺性脑病

Noninvasive Bi-level Positive Airway Pressure Ventilation in Pulmonary Encephalopathy due to Chronic Obstructive Pulmonary Disease

【目的】评价双水平无创正压通气（BiPAP）对慢性阻塞性肺疾病呼吸衰竭合并肺性脑病治疗的可行性及疗效。【方法】30例慢性阻塞性肺疾病呼吸衰竭合并肺性脑病的患者均在综合治疗的基础上，加用BiPAP治疗。采用自身前后对照。记录通气前，通气后2h、48h及脱机后24h血气分析。【结果】研究中实际应用IPAP为（16±2）cmH2O，EPAP为（8±3）cmH2O。氧流量4～6L／min。28例患者经机械通气后2h后血氧分压均达60mmHg以上，血氧饱和度达90％以上，意识障碍均得到改善、呼吸费力情况减轻，RR减慢，PH，PaO2升高及PaCO2，HR，RR下降均非常显著（P〈0．01），12～16h神志清楚。通气治疗持续时间平均为（72±24）h，通气治疗48h及撤机后经鼻导管及面罩吸氧（FiO2 40％）24h后RR减慢，PH，PaO2升高及PaCO2，HR，RR下降较通气治疗前有显著性差异（P〈0．05），无一例再需无创或有创通气治疗。2例患者病情加重，改行有创一无创序贯机械通气治疗，30例患者均好转出院。【结论】双水平无创正压通气对慢性阻塞性肺疾病呼吸衰竭并肺性脑痛治疗是可以尝试的方法之一。

[Objeetive]To evaluate the effect of non-invasive bi-level positive ventilation （BiPAP） in patients with pulmonary encephalopathy due to chronic obstructive pulmonary diseases （COPD） . [Methods]A study was conducted in 30 patients with pulmonary encephalopathy due to chronic respiratory failure. Each patient was added noninvasive positive pressure ventilation（NPPV） based on conventional management. Aterial blood gas （AGTB） analysis, HR, RR, PetCO2 were detected immediately before and at the end of each ventilation. [Results]The parameters were set as the S/T mode, IPAP （ 16 ± 2 ） em H2O, EPAP（8 ± 3） emH2O, FiO2 30% -40%. Of 30 patients,28 patients showed improvements in symptoms and gas exchange. The changes were significantly marked ,2 cases were intubated due to failure of BiPAP ventilation, no patients died. [Conclusion]BiPAP ventilation is an effective way in treating pulmonary encephalopathy due to chronic obstructive pulmonary disease.