无创正压通气治疗慢性阻塞性肺病急性加重期呼吸衰竭临床研究

The clinical research of noninvasive positive pressure ventilation on respiratory failure in acute exacerbation of chronic obstructive pulmonary disease.

目的评价无创正压通气(NPPV)治疗慢性阻塞性肺病(COPD)急性加重期呼吸衰竭的价值。方法收集2004年01月至2006年08月住我院重症监护室(ICU)54例COPD急性加重期呼吸衰竭的患者,观察所有患者在常规治疗基础上,进行NPPV治疗后的临床表现、动脉血气的变化。结果1例不能耐受、4例改用有创机械通气,49例患者经NPPV治疗2h后呼吸困难缓解,心率、呼吸频率下降(P<0.05),动脉血气指标、氧合指数改善(P<0.05)。结论NPPV能明显改善COPD急性加重期呼吸衰竭的症状、低氧血症、氧合指数及二氧化碳潴留,说明NPPV治疗有效,耐受性好,并发症少。

Objective To evaluate the value of noninvasive positive pressure ventilation （NPPV） on respiratory failure in acute exacerbation of chronic obstructive pulmonary disease （COPD）. Methods Fifty four patients with acute exacerbation of COPD from January 2004 to August 2006 were enrolled in intensive care unit （ICU） of our hospital. All inpatients received NPPV based on routine therapies. Changes of clinical manifestation and arterial blood gas were observed. Results One case couldn＇t tolerate. Four cases received sequential invasive and noninvasive treatment. Forty nine patients showed improvement in dyspnea. Heart rate and respiratory rate decreased （ P 〈 0. 05 ） with improvement of arterial blood gas parameters and PaO2/FiO2 （ P 〈 0. 05 ） after NPPV for two hours. Conclusion NPPV is effective to improve clinical symptoms of hypoxemia, of PaO2/FiO2 and dioxide reservation of patients. NPPV are effective in treating patients with respiratory failure in acute exacerbation of COPD with well tolerance and less complications.