无创正压通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭临床观察

Clinical study of non-lnvasive positive pressure ventilation on chronic obstructive pulmonary disease complicating with type II respiratory failure

目的探讨经面罩双水平气道正压通气（bi-level positive airway pressure，BiPAP）呼吸机治疗慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）合并Ⅱ型呼吸衰竭的疗效。方法88例COPD并发Ⅱ型呼吸衰竭患者随机分为治疗组和对照组，两组均给予抗感染、解痉平喘、止咳祛痰、能量支持等常规治疗，对照组加低浓度氧疗，治疗组加面罩BiPAP呼吸机治疗。观察面罩舒适度、临床症状、血气分析、生命体征、肺功能、漏气情况及不良反应。结果治疗组与对照组相比，治疗72h后心率、呼吸频率、动脉血二氧化碳分压、pH值均明显下降，住院天数缩短，动脉血氧分压、动脉血氧饱和度、肺活量、用力肺活量及第1秒用力呼气容积明显上升，差异均具有统计学意义（P＜0．01）。治疗组总有效率86．4％（38／44）与对照组68．2％（30／44）相比差异有统计学意义（P＜0．05）。结论COPD合并呼吸衰竭患者早期使用BiPAP呼吸机治疗，对肺功能、低氧血症和CO2潴留改善明显，疗效显著。

Objective To discuss the curative effect by mask bi-level positive airway pressure（BiPAP） ventilator for chronic obstructive pulmonary disease（COPD） complicating with type II respiratory failure. Methods Eighty-eight patients of COPD complicating with type II respiratory failure were randomly divided into the comparison group and the treatment group,two groups were given the anti-inflammation, evenly breathes heavily,the spasmolysis, relieves a cough, the phlegm reduction conventional treatment and so on energy support. The comparison group was addsed the low concentration oxygen treatment, the treatment group received mask BiPAP ventilator treatment. Mask comfort, clinical symptoms, blood gas analysis, vital signs, lung function, air leakage situation and adverse reactions were observed. Results The treatment group and the comparison group compare, the treatment 72 after hour of heart rate, respiratory rate,arterial partial pressure of carbon dioxide, pH obviously drop, is hospitalized the number of days to reduce,arterial partial pressure of oxygen, arterial oxygen saturation, vital capacity, forced vital capacity, forced expiratory volume in first second obvious rise, the difference has statistics significance（ P〈0.01 ）. The treatment group total effectiveness 86.4%（38/44） and the comparison group 68.2% （30/44） compares the difference to have statistics significance（ P〈0.05）. Conclusions The COPD complicating with type Ⅱ respiratory failure patient early time uses the BiPAP ventilator treatment, to the lung function, the low oxygen blood sickness and retention of CO2 improves obviously, the curative effect is remarkable.