无创正压通气治疗COPD呼衰伴意识障碍的临床研究

Clinical Research of Using Noninvasive Positive Pressure Ventilation on Treatment of Respiratory Failure Due to Chronic Obstructive Pulmonary Disease with Conscious Disturbance

目的探讨无创正压通气(NPPV)对慢性阻塞性肺疾病(COPD)呼吸衰竭伴意识障碍患者的疗效。方法将110例患者依据是否伴有意识障碍分为两组,根据Glasgow昏迷评分(GCS)将意识障碍组分为轻度意识障碍、中度意识障碍、重度意识障碍3层。两组均接受NPPV治疗,根据动脉血气和临床症状的改善情况进行疗效评价。结果经NPPV治疗,伴意识障碍组患者有效率为75.93%,不伴意识障碍组有效率为85.71%,两组差异无统计学意义(P>0.05)。轻度意识障碍、中度意识障碍、重度意识障碍各层NPPV的疗效分别为68.75%、94.12%和66.67%,中度意识障碍NPPV的疗效高于轻度意识障碍和重度意识障碍(P<0.05)。结论NPPV对COPD呼吸衰竭伴意识障碍患者有较好的疗效,中度意识障碍患者疗效可能最佳。

Objective To investigate the efficacy of noninvasive positive pressure ventilation（NPPV） in the patients with conscious disturbance due to chronic obstructive pulmonary disease（COPD） and respiratory failure. Method 110 cases of patients with COPD and respiratory failure were divided into two groups： conscious disturbance group and unconscious disturbance group. Furthermore, conscious disturbance group was divided into mild,moderate and severe groups according to Glasgow Coma Scale（GCS）. All cases received noninvasive posi- tive pressure ventilation in addition to conventional medications. Benefits of NPPV were evaluated based on the improvement of artery blood gases and clinical symptoms. Results The effective rates of NPPV in conscious disturbance group and in unconscious disturbance group were 75.93% and 85.71% respectively. There were no significant difference between two groups（P〉0.05）. The effective rates of NPPV in mild,moderate and severe groups were 68. 75% ,94. 12% and 66.67% respectively. The effective rate of NPPV was significantly higher in moderate groups than in mild and severe groups（P〈0.05）. Conclusion NPPV has obvious effect on conscious disturbance due to COPD patients with respiratory failure, especially on moderate conscious disturb- ance patients.