无创正压通气治疗慢性阻塞性肺疾病急性加重期的疗效和费用分析

Analysis of the effect and economics of no-invasive positive-pressure ventilation(NIPPV)in treating chronic obstructive pulmonary diseases(COPO) acute exacerbation

目的探讨无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)急性加重期患者的疗效,并调查其医疗费用。方法选择我院收治的COPD急性加重期伴有Ⅱ型呼吸衰竭患者121例,分为两组:对照组(59例)为2001～2002年收治的以药物治疗为主者。治疗组(62例)为2003年至2005年收治的以无创正压通气加药物治疗者。观察两组治疗前后的呼吸频率、心率、肺部啰音和动脉血气等指标.比较两组患者的平均住院天数及药物、无创呼吸机通气、普通病房、ICU病房、护理和总住院费用。结果二组患者在治疗后其呼吸频率、心率、肺部啰音均有所改善,以治疗组改善明显,两组比较有显著性差异(P<0.05)。治疗组接受无创双水平正压通气(BiPAP)治疗结束时(低流量吸氧、自主呼吸4h以上)患者动脉血气显著改善(P<0.05)。治疗组的平均住院天数(13d)较对照组(21d)短。治疗组的ICU病房费用、护理费用、药物治疗费用及住院总治疗费用均较对照组少,两组比较有显著性差异[治疗组分别为(600±200)元,(117±27)元,(3546.2±359.4)元,(8079.42±1153.27)元,对照组分别为(1600±400)元,(207±36)元,(4673.5±396.4)元,(8925.12±1063.42)元,P<0.05]。结论无创正压通气治疗COPD急性加重期合并呼吸衰竭的疗效是肯定的。同时缩短了平均住院天数,降低平均总住院费用。

Objective To analyse the effect and economics of NIPPV in treating COPD in acute exacerbation with. Methods 121 cases of COPD in acute exacerbation with respiratory falure （RF） were divided into two groups, 59 cases in the control group with drug treatment, 62 cases in the study gruoup were treated with NIPPV. Analysis was performed for parameters such as breath rate, the heart rate and rales of lung before and after treatment. The ABG＇s before and after the treatment was compared. The average hospitalization stay and patient costs（ICU cost, the respiratory nurse cost, cost of drug treatment etc.） were compared between the two groups. Results The treatment group had shourter average hospitaluzation stay than the control group. Further more, the hospitalization of cost of the treatment group was remarkably less than that in the control group （P〈0.05）. For the ICU cost, the respiratory nurse cost and cost of drug treatment, we found that those of the treatment group was lower than the control group. The difference was signigicant between the two groups （P〈0.05）. Conclusions This study suggests that NIPPV treatment is effective in the treatment of COPD acute exacerbation. It can reduce hospitalization stay and average cost. It can also improve the residual lung function.