双水平气道正压通气对慢性阻塞性肺疾病急性加重期合并呼吸衰竭的治疗作用

The therapeutic effect of bilevel positive airway pressure ventilation on chronic obstructive pulmonary disease complicated with respiratory failure in acute deteriorative period

目的探讨经鼻面罩双水平气道正压通气(BiPAP)在慢性阻塞性肺疾病(COPD)急性加重期合并呼吸衰竭的治疗作用。方法将46例COPD合并急性呼吸衰竭患者随机分为2组,每组23例,标准治疗组给予常规抗感染、支气管扩张剂、呼吸兴奋剂、祛痰药、激素、氧疗、纠正酸碱失衡的治疗。经鼻面罩BiPAP治疗组在标准治疗的基础上,采用美国伟康公司BiPAP Harmony S/T型呼吸机进行辅助通气。观察2组患者治疗前后生命体征及血气分析变化,比较插管率、病死率、住院时间、住院费用。结果2组治疗24h后,BiPAP治疗组在心率、呼吸频率、血气方面均显著优于标准组(P<0.05),BiPAP组插管率、病死率、住院时间、住院费用较标准治疗组明显降低(P<0.05)。结论经鼻面罩BiPAP通气适合治疗COPD合并急性呼吸衰竭患者,其在改善临床症状和动脉血气指标方面均优于标准治疗,可明显缩短住院时间,降低住院费用,降低插管率、病死率。

Objective To investigate the therapeutic effect of bilevel positive airway pressure （BiPAP） ventilation on chronic obstructive pulmonary disease （COPD） in acute deteriorative period complicated with respiratory failure.Met/Kids Forty-six COPD patients complicated with respiratory failure were randomly divided into two groups,23 patients in each group. The 23 patients in routine treatment group were treated by anti-infection, bronchodilators, respiratory stimulant, apophlegrnatisant, excitatory autacoid, oxygen therapy, rectification of acid-base balance. The other 23 patients in BiPAP treatment group, on the basis of routine therapy, were treated by non-invasive mechanical ventilation with BiPAP S/T mode. The vital sign, chance of blood gas analysis, rate of intubation, mortality, duration and cost of hospitalization were compared between the two groups. Results Compared with those in routine treatment group, the heart rate, respiratory frequency and the parameters of blood gas in BiPAP treatment group were improved significandy after the treatment for 24 hours （ P 〈 0.05 ）. The mortality, intubation rate, duration and cost of hospitalization were signifieandy decreased in BiPAP treatment group, as compared with those in routine treatment group （ P 〈 0.05 ）. Conclusion The BiPAP ventilation by faeemask through nose could obviously improve the clinical symptoms and arterial blood gas parameters of the patients, which is suitable for the treatment of the COPD patients complicated with respiratory failure, which could reduce the mortality, rate of intubation, duration and cost of hospitalization of COPD patients.