头罩式无创正压通气在慢性阻塞性肺疾病急性加重患者中的临床应用

Clinical use of noninvasive positive pressure ventilation using a helmet in patients with acute exacerbation of chronic obstructive pulmonary disease

目的评价应用头罩式无创正压通气（non-invasive positive pressure ventilation，NIPPV）治疗慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease，AECOPD）患者的疗效。方法选择符合标准的AECOPD患者40例，随机分为头罩组（A组，20例）和面罩组（B组，20例）。观察指标包括简化急性生理状况评分Ⅱ、动脉血气、呼吸频率、心率、氧合指数（PaO2／FiO2）、初始24h治疗中断例数和频数、需气管插管率、住院病死率、气管插管原因等。结果NIPPV治疗结束后，两组患者均有PaCO2的下降和pH的改善，但差异无统计学意义。A组患者气管插管率与B组间差异无统计学意义。A组没有患者不能耐受NIPPV治疗，B组有3例患者因不能耐受而需行气管插管（P〈0．05）。两组患者住院病死率间差异无统计学意义。两组患者初始24h治疗中断例数和频数间差异有统计学意义（P〈0．01）。两组患者并发症总发生率间差异有统计学意义（P〈0．01）。结论头罩NIPPV治疗可用于AECOPD患者，它能够提高患者的耐受性，减少与NIPPV相关的并发症，但在改善气体交换和降低气管插管方面与面罩相比无明显优势。

Objective To evaluate the efficacy of non-invasive positive pressure ventilation（NIPPV） for acute exacerbation of chronic obstructive pulmonary disease（AECOPD） patients by a helmet. Methods Forty AECOPD patients were randomly assigned to helmet treatment （group A, n = 20） and facemask treatment （group B, n = 20）. To analyze simplified acute physiologic score,gas exchange, respiratory rate, heart rate, PaO2/FiO2, the number and frequency of discontinuation in first 24 h, patients requiring intubation,hospital mortality, reason of endotracheal intubation. Results After NIPPV treatment, PaCO2 declined and pH improved in two groups, but with no significant difference. The need for intubation in group A and group B had no significant difference. No patients were unable to tolerate NIPPV in group A,whereas 3 patients required intubation in group B（ P〈0.05）. Hospital mortality was similar between two groups. The number and frequency of discontinuation in group A was significantly less than that in group B in the first 24 h of application （ P〈0.05）. The complications between two groups had no difference（ P〈0.01）. Conclusions Helmet NIPPV is feasible and can be used to treat AECOPD patients,it can improve patients＇ tolerance, and decrease complications related to NIPPV, but it does not improve CO2 elimination and decrease the need for intubation as efficiently as FM group does.