双水平气道正压无创通气对AECOPD合并Ⅱ型呼吸衰竭52例疗效观察

Observatinon on therapeutic effect of bi-level positive airway pressure noninvasive ventilation on 52 cases of chronic obstructive pulmonary disease with type Ⅱ respiratory failure

目的探讨双水平气道正压无创机械通气（BiPAP）对慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭早期患者肺功能、血气分析、功能性呼吸困难分级的影响。方法对100例慢性阻塞性肺疾病急性发作期（AECOPD）合并Ⅱ型呼吸衰竭患者分为常规对照组（A组）和无创通气治疗组（B组）,其中A组48例,B组52例;A组与B组在治疗前及治疗后第3天均分别作肺功能测定、呼吸困难指数评分;在治疗前,治疗后2、4、8、72h分别作血气分析、每分钟呼吸频率（RR）测定。结果（1）B组与A组比较,肺功能及呼吸困难指数均明显改善（P〈0.05）。（2）B组在治疗后4小时血气分析pH、PCO2、PO2及RR均改善（P〈0.05）,8h后更明显（P〈0.01）,72h呼吸衰竭已基本纠正（P〈0.01）。结论双水平气道正压无创机械通气能明显改善AECOPD患者肺功能、呼吸困难指数,较快纠正Ⅱ型呼吸衰竭,是治疗早期呼吸衰竭的一个重要手段。

Objective To investigate the effect of bi-level positive airway pressure noninvasive ventilation （BiPAP） on the lung function, blood gas analysis and dyspnea score of patients with chronic obstructive pulmonary disease with type Ⅱ respiratory failure. Methods one hundred patients with COPD complicating by respiratory failure were randomly divided into control group （ groupA, n = 48 ） and treated group （ groupB, n = 52 ）. Lung function tests were performed, and dyspnea score were counted before treatment and after three days of treatment; Respiratory frequency was observed and blood gas parameters including pH, PO2, PCO2 were recorded before treatment and after two hour, four hour, eight hour, seventy-two hour of threatment. Results （1） compared with groupA, dyspnea score in group B decreased and lung function were improved（P〈0.05）. （2）The values of PH and PO2 greatly improved and PCO2 significantly decreased in group B after four hour of threatment（ P 〈 0.05 ） and after eight hour of threatment（ P 〈0.01）, and respiratory failure were rectified after seventy-two hour of threatment（ P 〈 0.01 ）. Conclusion Using BiPAP respiratory machine assistant ventilation can improve lung function,decrease dyspnea score, and rectify rapidly respiratory failure, and it were effective for patients with COPD complicating by respiratory failure.