早期无创通气治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭的临床研究

Clinical study on the early application of noninvasive ventilation in COPD in acute exacerbation stage with respiratory failure

目的:探讨早期无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)急性加重期合并呼吸衰竭的价值。方法:采用前瞻性随机对照研究将96例COPD患者分为标准治疗对照组和标准治疗+双水平正压通气(BiPAP)观察组;观察治疗前后的临床指标和动脉血气。结果:治疗后观察组患者的呼吸频率(RR)、心率(HR)、动脉血pH、PaO2、PaCO2、SaO2均较前有明显的改善(P<0.01)。与对照组比较,观察组治疗24、48、72 h后的pH值、PaO2和SaO2上升更明显,PaCO2下降更明显(P<0.01),住院时间短(P<0.01);死亡率降低(P<0.05);但两组患者插管率无明显差异(P>0.05)。结论:COPD急性加重期合并呼衰早期应用BiPAP可更快的缓减患者的临床症状,提高PaO2,降低PaCO2,缩短住院时间,降低死亡率。

Ojective：To evaluate the value of early application of noninvasive ventilation in COPD in acute exacerbation stage with respiratory failure.Methods：96 COPD patients with hypercapnia were involved in the study,the patients were randomized into two greups：BiPAP group（standard-therapy plus BiPAP group） and control group（standard-therapy greup）.The clinical outcome and arterial blood gas parameters were observed before and after treatment. Results：After treatment, both groups had significant improvement in HR、 RR、pH、PaO2、PaCO2 and SaO2 （P〈0.01）.But improvement in pH、PaO2、PaCO2、SaO2 in BiPAP group was more rapid and significant thanthat in control group at 24,48,72 h （P〈0.01）,BiPAP group also lowered the lentil of hospital stay and hospital mortality. The rate of endotrecheal intubation was no significant difference between two group （P〉0.05）. Conclusion：The early application of noninvasive ventilation in COPD in acute exacerbation stage with respiratory failure can rapidly improve the clinical symptoms, heighten arterial oxygen tension,lower PaC02 and lower lentil of hospital stay and hospital mortality.