双水平气道正压通气治疗慢性阻塞性肺疾病急性加重期并发呼吸衰竭的临床研究

Efficacy of Non-invasive Bi-level Positive Airway Pressure Ventilation in the Patients with Type Ⅱ Respiratory Failure due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:评价经口鼻面罩双水平气道正压通气(BiPAP)治疗慢性阻塞性肺疾病急性加重期(AECOPD)并发Ⅱ型呼吸衰竭的临床疗效。方法:对照组30例AECOPD并Ⅱ型呼吸衰竭患者给予吸氧、抗感染、化痰平喘等常规治疗,观察组38例AECOPD并Ⅱ型呼吸衰竭患者,在常规治疗的基础上同时进行BiPAP通气治疗。观察两组治疗前及治疗后4 h2、4 h及72 h动脉血气变化,比较治疗前后呼吸频率、心率和白细胞计数以及血浆内皮素-1含量的变化,观察两组住院时间、气管插管率及病死率的变化。结果:观察组治疗后4 h、24 h及72 h动脉血气pH、PaO2、SaO2、PaO2/FiO2均明显高于对照组(P<0.05),PaCO2明显下降(P<0.05)。呼吸频率、心率和白细胞计数较对照组均下降(P<0.05)。观察组血浆内皮素-1含量恢复至正常水平快于对照组,观察组和对照组患者住院时间、气管插管率及病死率均有显著性差异(P<0.05)。结论:BiPAP治疗慢性阻塞性肺疾病急性加重期并发Ⅱ型呼吸衰竭患者疗效确切,能减少住院时间、降低插管率和病死率。

Objective： To evaluate the clinical effect of non-invasive Bi-level positive airway pressure ventilation （Bi-PAP） in the patients with type Ⅱ respiratory failure who suffered from acute exacerbation of chronic obstructive pul-monary disease （AECOPD）. Methods： The patients in control group （30 cases） who suffered from AECOPD with type Ⅱ respiratory failure were treated with conventional therapeutic management such as antibiotic, receiving continual low-flow oxygen, pacifying gasp, eliminating phlegm. Thirty-eight patients of AECOPD with type Ⅱ respiratory failure in experiment group were treated with BiPAP as well as conventional therapeutic management. Arterial blood gases were analyzed. The changes of clinical signs and the plasma level of endothelin-1 were observed, and the duration of hospital stay and the rate of mortality and endotracheal intubation were recorded after treatment. Results： The data of arterial blood gases, pH, VaO2 , SaO2 , PaO2/FiO2 in experiment group were higher significantly than those in control group after 4 h, 24 h and 72 h BiPAP treatment, but PCO2 declined significantly （P〈0.05）. There was significant difference in respiratory rate, heart rate, and white cell count between the experiment group and the control group （P〈0.05）. The plasma level of endothelin-1 decreased faster in the experiment group than that in the control group, so did hospital days, endotracheal intubation rate and mortality rate （10.5±5.4 vs. 18.7±8.5; 10.5% vs. 30.0% ; 7.8% vs. 20.0%, respectively） （P〈0.05）. Conclusion： BiPAP is an effective therapy for the patients with AECOPD combined type Ⅱ respiratory failure. It can reduce duration of hospital stay and decrease the intubation rate and mortality rate.