无创通气治疗慢性阻塞性肺部疾病轻中度呼吸衰竭疗效观察

EARLY USE OF BIPAP VENTILATION FOR ACUTE MILDLY AND MODATELY RESPIRATORY FAILURE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

目的探讨BiPAP经鼻罩或口鼻罩正压通气,对COPD轻中度呼吸衰竭早期无创通气的应用价值。方法将36例患者随机分为治疗组和对照组,两组各为18例。治疗组给予常规治疗加BiPAP通气,对照组单予常规治疗。在治疗前和治疗后2h及10h分别检测血气、呼吸频率(RR)和心率(HR),出院时统计插管率、病死率和住院天数。结果两组病人在治疗10h后PH、PaCO2、PaO2、RR和HR均得到明显改善(P<0.01),治疗组在治疗2h后PaCO2、RR和HR改善优于对照组(P<0.01)。两组需要插管机械通气分别为3例(16.3%)和7例(38.9%),差异无统计学意义(P>0.05)。治疗组死亡率2例(11.1%),对照组5例(27.8%),无统计学意义(P>0.05)。两组住院天数分别为(21±12)d和(32±19)d(P<0.05)。结论早期使用无创通气治疗能较快地改善COPD轻中度急性发作的通气功能,缩短住院天数。

Objective To access the efficacy ofbilevel positive airway pressive （BiPAP） ventilation in mildly and moderately respiratory failure of due to acute exacerbations of chronic obstructive pulmonary disease （COPD）.Methods 36 patients were recruited,18 received standard therapy alone and 18 additional BiPAP. Results In broth groups PH, PaCO2, respiratory rate and heart rate improved significantly after ten hours of treatment （P〈0.01）. However, BiPAP led to a more rapid fall in PaCO2, respiratory rate and heart rate at 2h （P〈0.01）. Compared with standard therapy, the use of BiPAP did not reduced the need for endotracheal intubation and the in-hospital mortality rate （P〉0.05,respeetively）, but shoter the mean in-hospital days （P〈 0.05）.Conclusion In patients with acute mildly and moderately exacerbations of chronic obstructive pulmonary disease （COPD）, the use of BiPAP can leads to more rapid improvement of lung ventilatory function and shoter the length of the hospital stay.