BiPAP配合经鼻/口声门下痰液引流治疗AECOPD合并严重呼吸衰竭临床观察

The clinical observation of acute period of chronic obstructive pulmonary disease patients accompanied with respiratory failure treated by BiPAP

目的观察BiPAP配合痰液引流治疗慢性阻塞性肺疾病急性期合并严重呼吸衰竭临床效果，判断其临床可行性。方法27例AECOPD，支气管一肺部感染合并严重呼吸衰竭，痰液较多患者，在基础治疗同时，按需经鼻／口声门下痰液吸引，给与无创通气治疗，记录并比较治疗前及治疗后6～12h和治疗停用无刨24h后RR HR PH PaCO2 PaO2指标情况，及计算治疗有效率、再感染率等。结果治疗有效率77．8％，各指标变化明显，存在统计学意义；经鼻／口声门下痰液引流后再发生肺部感染2例，再感染率12．5％，较常规气管插管所致呼吸机相关性肺炎感染率明显低。结论BiPAP无创通气在配合做好痰液引流后治疗COPD合并严重呼吸衰竭的效果明显。

Objective To investigate the clinical effect of chronic obstructive pulmonary disease patients with respiratory failure who treated by noninvasive bilevel positive airway pressure （BiPAP） support ventilation combined with draining sputum beneath glottis through nose or mouth, and to judge its clinical feasibility. Methods Clinical data of 27 cases of acute exacerbation of COPD and bronchus-pulmonary infection patients with severe respiratory failure and with plenty of sputum were analyzed. At the same time of basic treatment; we adopted draining sputum beneath glottis through nose or mouth and noninvasive ventilation and recorded and compared the indexes of RR, HR, PH, PaCO2, PaO2 before the therapy and 6-12h and 24h after stopping the noninvasive treatment, and observed effective rate and reinfection rate. Results The effective rate was 77. 8%, the change of RR, HR, PH, PaCO2 , PaO2 had statistical significance. After draining sputum beneath glottis through nose or mouth, only 2 cases showed pulmonary infection, and the reinfection rate was 12.5 %. According to intubation, The occurrence of pneumonia related to resplratory machine was very low. Conclusion BIPAP noninvasive ventilation have obvious effect on COPD patients with severe respiratory failure after draining sputum.