无创正压通气治疗AECOPD并Ⅱ型呼吸衰竭日通气时间的探讨

Study of the optimal length of treating time everyday on the patients with acute exacerbation of chronic obstructive pulmonary disease and hypercapnic respiratory failure

目的探讨无创正压通气(NPPV)治疗AECOPD并发Ⅱ型呼吸衰竭每天最佳通气时间。方法将AECOPD并Ⅱ型呼吸衰竭60例患者随机分为间歇组和持续组。比较治疗前后及两组间临床症状改善的情况、动脉血气的变化、平均住院日、气管插管率及面罩副反应。结果两组在治疗后心率、呼吸频率逐渐减慢,血气分析指标有明显改善,与治疗前比较有显著性差异。两组间比较,在心率、呼吸频率、气管插管率等方面无显著性差异;而两组间的平均住院日、面罩副反应及治疗后的血气分析指标在24小时、尤其是72小时的改善有显著性差异。结论NIPPV治疗AECOPD并发呼吸衰竭,能够明显改善临床症状;持续NPPV治疗能够较快的改善患者的血气指标,缩短患者的住院时间;持续通气会增加患者出现面罩副反应的几率,两种治疗方法在气管插管率方面无明显差异。

Objective To investigate the optimal length of time everyday that noninvasive positive-pressure ventilation（NPPV） is used in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） with hypereapnic respiratory failure （HRF）. Methods Sixty patients with AECOPD and HRF were randomly divided into continuous and intermittent groups. The clinical improvement, changes in artery blood gas （ ABG）, average length of stay, the rate of intubation and mask reactions were compared between the two groups before and after the treatment. Results The heart rate （HR） and the breath rate （RR） of the patients in the beth groups were gradually slowed down and the blood gas analysis indexes were improved after the NPPV treatment. There axe no differences in HR, RR and intubation rate between the two groups after the NPPV. The average length of stay, side effect of the mask and the index of the ABG after 24 hours and 72 hours were different significantly. Conclusions NPPV is a excellent treatment for AECOPD with HRF; continuous NPPV can improve the blood analysis index more quickly and shorten the patients＇ hospitalized time, but it can increase the side effect of the mask. There is no difference in the intubation rate between the two groups.