无创正压通气治疗慢性阻塞性肺疾病急性加重期并Ⅱ型呼吸衰竭临床分析

Clinical analysis of noninvasive positive pressure ventilation for chronic obstructive pulmonary disease complicated with respiratory failure.

目的 采用回顾性方法总结无创正压通气（NPPV）对慢性阻塞性肺疾病急性加重期（AECOPD）并Ⅱ型呼吸衰竭的治疗效果,分析治疗的相关因素.方法 对2001年1月至2005年12月广州市番禺区人民医院呼吸内科112例AECOPD并Ⅱ型呼吸衰竭患者在普通病房使用NPPV治疗,并对有效组与无效组进行临床分析.比较两组在NPPV治疗前、治疗1～2 h、24 h及治疗结束后心率（HR）、呼吸频率（RR）、血气分析的变化.结果 有效组NPPV治疗1～2 h后PaO2、PaCO2明显改善;24 h后氧合指数（OI）、HR、RR、SaO2、PaO2、PaCO2、pH明显改善.无效组治疗1～2 h后与治疗前相比PaO2、PaCO2,无明显改善,治疗24h后各指标也无改善.结论 AECOPD并Ⅱ型呼吸衰竭可在普通病房应用NPPV救治,治疗1～2 h、24h后血气分析、HR、RR明显改善的患者预后较好.

Objective To review and summarize the therapeutic effect of noninvasive positive pressure ventilation （NPPV） on treating chronic obstructive pulmonary disease （COPD） complicated with respiratory failure, and to analyse correlative factors that affect therapeutic effect. Methods One hundred and twelve patients with acute exacerbations of COPD complicated with respiratory failure were treated with NPPV, and the experiences were summarized. The arterial blood gas analysis, respiratory rate, and heart rate of the two group patients were compared with before NPPV treatment, after 1 - 2 hours and 24 hours of NPPV treatment. Results PaO2 and PaCO2 in success group were improved rapidly after ventilating 1 - 2 hours, P 〈 0. 05. And OI, HR, R, SaO2 , Pa02, PaCO2 , pH were improved rapidly after ventilating 24 hours. However, the indexes were not improved rapidly in failure group after ventilating 1 - 2 hours, P 〉 0.05 ; moreover, there were no different improvement after ventilating 24 hours,P 〉0. 05. Conclusion NPPV can be used in the general ward for those of acute exacerbations of COPD （AECOPD） complicated with respiratory failure;prognosis is better if the patient is improved in blood gas analysis, respiratory and heart rate after ventilating 1 -2 hours and 24 hours.