BiPAP无创通气治疗COPD合并Ⅱ型呼吸衰竭疗效观察

Effect of BiPAP on COPD Patients with Type Ⅱ Respiratory Failure

目的探讨双水平正压无创通气(BiPAP)对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的治疗价值。方法70例COPDⅡ型呼衰患者中随机分成通气组和对照组,对照组给予常规抗感染、平喘、祛痰对症治疗和低浓度氧疗,通气组除了常规治疗外,加无创机械通气(BiPAP)治疗,采用通气口鼻面罩,设定参数S/T模式,呼吸频率14～20次/min,氧浓度40%左右,吸气压(IPAP)以10cmH2O开始,逐渐增加压力至25cmH2O,呼气压(EPAP)3～6cmH2O,每日上机2次,每次3h,7d为1个疗程。结果通气组治疗后动脉血气分析中pH值和PaO2逐渐上升,PaCO2值下降,临床症状改善,减轻呼吸肌疲劳,减慢呼吸频率和心率,呼吸困难减轻。结论本法治疗COPD合并Ⅱ型呼吸衰竭有效,减少气管插管或气管切开以及相应的并发症,减少病人的痛苦和医疗费用。

Objective To evaluate the clinical effect of noninvasive BiPAP ventilation on COPD patients with type Ⅱ respiratory failure. Methods 70 COPD patients with type H respiratory failure were randomly divided into aeration group and control group. Cases in control group were given anti-infection, eliminating phlegm, relieving asthma and inhaling low concentration oxygen. The aeration group were treated with noninvasive BiPAP ventilation in addition to routine treatment, the respirometer parameters were ：S/T model, respiratory frequency 14-20/min, oxygen concentration 40% , IPAP raised gradually from 10 cmH2O to 25 cm H2O, EPAP 3-6 cm H2O, twice a day,3 hours each time ,7 day as a period. Results The arterial pH and PaO2 of all cases in aeration group elevated gradually and the PaCO2 declined, the clinical symptoms improved also. Noninvasive BiPAP ventilation could relieve respiratory muscle fatigue, reduce heat rate and respiratory frequency, assuage dyspnoea. Conclusions It is affirmative that the noninvasive BiPAP ventilation is effective on COPD with type H respiratory failure patients treatment. It could avoid trachea intubation or incision, and their complications,then assuage the affliction of patients and also reduce the medical expenses.