双水平气道正压通气治疗慢性阻塞性肺疾病呼吸衰竭昏迷患者的疗效评价

Bi-level positive airway pressure ventilation in treatment of comatose patients with respiratory failure due to chronic obstructive pulmonary disease:evaluation of therapeutic effectiveness

目的评价双水平气道正压(BiPAP)通气治疗慢性阻塞性肺病(简称慢阻肺)呼吸衰竭昏迷患者的疗效。方法选择呼吸内科RICU慢阻肺呼吸衰竭患者28例,其中昏迷组13例,非昏迷组15例。均采用双水平气道正压通气治疗。结果昏迷患者通气2～4h后,pH值从(7.191±0.051)升至(7.366±0.063),PaCO2从(99.45±14.21)mmHg降至(66.3±13.2)mmHg;多数患者意识转清,并恢复正常的咳痰能力。10例(76.9%)患者平均通气7d后恢复至稳定的自主呼吸状态和较满意的动脉血气水平。与非昏迷组比较疗效相似(P>0.05),但较多患者需用时间控制模式通气,且有较高的胃胀气发生率。结论昏迷不应是BiPAP无创通气的禁忌证;加强昏迷患者意识清醒前气道分泌物的清除及胃肠胀气的引流,合理选用机械通气模式是成功的关键。

Objective To evaluate the effect of Bi-level positive airway pressure ventilation in unconscious patients with respiratory failure due to chronic obstructive pulmonary disease（COPD）. Methods From January 2003 to June 2006,28 case of COPD patients with severe respiratory failure were included in the study. 13 comatose cases among 28 patients were in the comatose group, and the rest non-comatose patients in the control group. Comparison was made between the therapeutic effectiveness of bi-level positive airway pressure ventilation in 13 comatose patients and that of non-comatose patients . Results After ventilating 2-4 hr, pH increased from （7.191±0. 051 ） to （7. 366±0. 063 ） and PaCO2 from （99.45±14.21 ）mmHg to （66.3±13.2 ） mmHg;most patients became conscious and able to expectorate on their own. 76.9% of patients resumed a stable autonomic respiration and the values of their arterial blood gases became better than before, after an average of 7 days. The therapeutic effectiveness in comatose patients was similar to that in non-comatose patients, but more patients with coma needed to change to time control mode ventilation. Incidence of gastric insufllation was higher in comatose patients than in non-comatose patients. Conclusions Coma is not a contraindication of bi-level positive airway pressure ventilation. Rational selection of ventilating mode, fully draining the sputum and gastric insufllation before the patients become conscious is the key to the successful treatment.