BiPAP通气治疗慢性阻塞性肺疾病急性加重伴意识障碍的疗效观察

EFFICACY OF BiPAP VENTILATION IN PATIENTS WITH HYPERCAPNIC ENCEPHALOPATHY DUE TO ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

[目的]探讨无创双水平气道正压（BiPAP）通气治疗慢性阻塞性肺疾病急性加重（AECOPD）呼吸衰竭合并意识障碍患者的疗效。[方法]收集AECOPD呼吸衰竭合并意识障碍患者50例，随机分为治疗组（BiPAP治疗组）及对照组（常规治疗组），每组25例。观察治疗前后患者的生命体征及血气的变化。[结果]治疗24h后治疗组患者pH、PaO2、PaCO2及RR的改善明显好于对照组（P〈0．05）；治疗组及对照组的有效率分别为84％，68％，差异有统计学意义（P〈0．05）。治疗组治疗2～4h后血气指标明显改善（P〈0．05），24h后各项观察指标均显著好转（P〈0．05），至治疗结束时相对稳定。[结论]BiPAP是治疗AECOPD呼吸衰竭合并意识障碍患者的有效手段。初期BiPAP通气治疗应持续24h以上。

[ Objective] To evaluate the efficacy of face-masked double horizontal positive airway pressure （BiPAP） ventilation in patients with disturbance of consciousness and respiratory failure due to AECOPD. [Methods] 50 patients were randomly divided into two groups. The control group was treated by conventional medical therapy and the treatment group was treated by conventional medical therapy plus BiPAP ventilation .The arterial blood-gas, respiration rate （RR）, heart rate （HR） were monitored respectively at the start and end of therapy. [Results] The improvements in pH, PaO2, PaCO2 and RR in treatment group were much better than those in control group （P 〈 0.05） ; the efficacy rate was higher in treatment group （84%） than that in control group （68%）, P〈 0.05. Within the first 2-4 hour, BiPAP ventilation significantly improved arterial blood - gas levels. After the 24 hours＇ therapy, all observed indexes significantly improved and were stabile until the end of therapy in treatment group. [Conclusions] BiPAP ventilation is a useful therapeutic measure for patients with disturbance of consciousneas and respiratory failure due to AECOPD.