无创正压通气治疗慢性阻塞性肺疾病并严重呼吸衰竭的临床研究

Clinical application of noninvasive positive pressure ventilation in chronic obstructive pulmonary disease complicated by severe respiratory failure

目的:观察使用双水平无创正压通气(BiPAP)模式治疗慢性阻塞性肺疾病(COPD)所至严重呼吸衰竭的临床疗效和副作用.方法:用无创正压通气(NPPV)治疗COPD所至严重呼吸衰竭患者54例(昏迷组27例,非昏迷组27例),观院,广东佛山528000)察平均住院日、气管插管率、病死率以及通气前后心率及血气指标变化.未使用呼吸机的常规治疗组26例做为对照.结果:NPPV组住院时间缩短,气管插管率和住院病死率下降,与常规治疗组比较有统计学差异;NPPV治疗组无论是昏迷患者还是非昏迷患者通气后心率下降、血气指标改善,与通气前比较有统计学差异.结论:用BiPAP模式行NPPV是治疗COPD所至严重呼吸衰竭的有效方法,合并意识障碍的患者也有效,及早应用能迅速缓解病情,缩短住院时间,降低病死率.

AIM： To investigate the clinical effect of noninvasive positive pressure ventilation （NPPV） on chronic obstructive pulmonary disease （COPD） complicated by severe respiratory failure. METHODS： Eighty COPD patients with severe respiratory failure were divided into 2 groups （conventional therapy group and NPPV group ）. And the NPPV group included 27 coma cases and 27 non-coma cases. The conventional therapy group included 26 non-coma cases. Arterial blood gas （ ABG）, days of NPPV, success ratio and adverse effects were investigated. RESULTS： NPPV increased PaO2 significantly, declined PaCO2 significantly and elevated blood pH. And NPPV decreased the rate of endotracheal intubation, length of stay and case-fatality rate. There were significant differences between the NPPV group and conventional therapy group（ P 〈 0.05 ）. And NPPV could significantly improve（P 〈0.05） artery blood gases rapidly in both of coma and non-coma cases after the therapy, but there was no significant difference between the coma and the non-coma cases （P 〉 0.05 ）. CONCLUSION： NPPV is effective for COPD patients with severe respiratory failure. It can improve artery blood gases rapidly, decrease the rate of endotracheal intubation, length of stay and case-fatality rate. Coma is not the absolute contraindication of NPPV treatment.