无创正压通气治疗COPD合并急性高碳酸血症性脑病的临床研究

Effect of Non-invasive Positive Pressure Ventilation in Treatment of Patients With COPD Complicated With Acute Hypercapnic Encephalopathy

目的：评价无创正压通气（NIPPV）治疗慢性阻塞性肺疾病（COPD）呼吸衰竭合并急性高碳酸血症性脑病（AHE）的有效性和安全性。方法：COPD呼吸衰竭合并AHE患者35例，在给予常规治疗的同时，使用口鼻面罩接受NIPPV治疗，监测患者的急性生理与慢性健康评分（APACHEⅢ）、意识状态评分（QCS）及通气参数，并作血气分析（ABG）测定。结果：所有患者在接受NIPPV治疗1h后氧合（PaO2／FiO2）明显增高（141±27VS183±31，P〈0．05），动脉血二氧化碳分压（PaCO2）和GCS评分有所改善。其中，10例患者在NIPPV治疗24h内因意识障碍加重而接受气管插管，其余25例（71．4％）在接受NIPPV治疗12h后神志逐步转清，24h后GCS评分均超过10，与治疗前比较，显著改善（11．2±0．7VS8．9±1．3，P〈0．05）。NIPPV治疗7d后，患者GCS评分均恢复至14～15，PaCO2则降至稳定期水平；APACHEⅢ评分、浅快呼吸指数（RSBI）和吸气压力（PS）也显著降低。结论：应用NIPPV能成功治疗COPD呼吸衰竭继发AHE患者。GCS评分〉8的AHE患者在持续NIPPV治疗24h后，GCs评分可显著增高，意识逐步转清，从而避免气管插管。

Objective： To evaluate the effect and safety of non-invasive positive pressure ventilation（NIPPV） in patients with chronic obstructive pulmonary disease （COPD） complicated with acute hypercapnic encephalopathy （AHE）. Methods： Thirty-five AHE patients were treated with NIPPV via face mask. The acute physiologic and chronic health evaluation （APACHE Ⅲ） score, Glasgow coma scale（GCS） score, ventilation parameter and arterial blood gas（ABG） were assessed. Results： All patients＇ oxygenation ratio（PaO2/FiO2） was increased significantly one hour after NIPPV（141 ± 27 vs 183 ± 31, P〈0. 05）, PaCO2 and GCS score were improved. Ten patients were intubated because of deterioration of consciousness within the first 24 hours. The other 25 patients GCS score was above 10 twenty-four hours after NIPPV support, much improved than that of before treatment（11.2 ± 0. 7 vs 8. 9 ± 1.3, P〈0. 05）. Patients GCS score recovered to 14-15 seven days after NIPPV treatment. PaCO2 was decreased to the stable stage. APACHE III score, rapid shallow breathing index（RSBI） and pressure support（PS） level were significantly decreased too. Conclusions ： COPD patients with AHE might be treated successfully with NIPPV. may significantly increased in patient with AHE whose GCS score was above 8 after receiving NIPPV treatment for 24 hours, and intubation may be avoided.