不同水平正压无创通气治疗COPD并发呼吸衰竭

Clinical Study on Non-invasion Positive Pressure Ventilation on Chronic Obstructive Pulmonary Diseases

目的:观察不同水平正压无创通气治疗慢性阻塞性肺疾病(COPD)患者的价值。方法:42例急诊COPD患者,按随机数字法分别予以低水平无创正压通气组(n=21,LB组)和较高水平正压通气组(n=21,HB组),记录通气前和通气后24 h心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、手指血氧饱和度(SpO2);同步测定动脉血pH值(pHa)、氧分压(PaO2)、二氧化碳分压(PaCO2)、乳酸(Lac),测定呼吸机面板上潮气量,并用标尺法了解患者主观感受。结果:HB组和LB组通气后PaO2分别为(94.6±10.4)mmHg和(81.6±10.3)mmHg,pHa分别为(7.41±0.047)和(7.43±0.048),PaCO2分别为(57.8±3.73)mmHg和(57.4±3.63)mmHg,Lac分别为(2.63±0.76)和(2.64±0.65)mmol/L。均比原有基础有明显好转,同时两组除PaO2外均无显著差异。而HB组潮气量为(446±102)mL,LB组为(388±117)mL,两组间有显著差异。患者主观舒适度LB组患者耐受性较好,未发现严重并发症。结论:适宜应用低水平正压无创通气治疗COPD,在ICU使用安全有效。

Objective：To observe the use of non-invasion positive pressure vent ilation（NIPPV） on chronic obstructive pulmonary diseases （COPD）. Methods： Forty-two patients were divided into two groups：high pressure support （HB） NIPPV and low pressure （LB） NIPPV. The data including heart rate（HR）, respiration rate（RR）,mean arterial pressure（MAP）,SPO2 was recorded before and 24 hours after exert respiration support. Also, the value of pH of arterial（PHa）, pressure of arterial oxygen（PaO2）, pressure of arterial carbon dioxide（PaCO2 ）and lactic acid （Lac） were measured spontaneously. To evaluate the effects of pressure, tidal volume was recorded. The index of comfort was obtained via a rule. Results：The PaO2 was（94.6±10. 4）mmHg in group of HB,and（81.6±10.3）mmHg in group LB. pHa was（7. 41±0. 047）and（7. 43±0. 048）respectively,PaCO2 was（57. 8±3.73）mmHg and（57. 4±3.63）mmHg respectively,Lac was（2.63±0.76） and （2.64±0. 65）mmol/L respectively. It was improved by the ventilation support. There were no difference between the two groups except the value of PaO2. Tidal volume in group of HB was higher than that of LB. The index of comfort of HB was worse than that of LB. Conclusion：The NIPPV is worth treating COPD in emergency. Also the low pressure support is recommended.