无创正压通气治疗慢性阻塞性肺疾病急性加重期合并严重呼吸衰竭的临床研究

Clinical Investigation of Non-Invasive Positive Pressure Ventilation in Treatment for Patients with Chronic Obstructive Pulmonary Disease and Severe Respiratory Failure

目的:评价无创正压通气(NIPPV)在救治慢性阻塞性肺疾病(COPD)急性加重期并严重呼吸衰竭患者中的临床疗效。方法:对2006年1月至2008年1月入选的47例COPD急性加重期并严重呼吸衰竭患者使用双水平无创正压呼吸机面罩辅助通气,患者均伴有不同程度的意识障碍,动态观察NIPPV治疗前和治疗后2 h、8 h、1 d及3 d动脉血气、神志、治疗后患者的转归,NIPPV的不良反应及并发症。结果:本组47例患者中,41例经NIPPV治疗2h8、h、1 d及3 d后与治疗前比较,PaO2明显升高P<0.01,PaCO2明显降低P<0.01,pH明显升高P<0.01,均脱机出院,有效率达87.23%(41/47);6例改为有创通气,其中3例经有创机械通气治疗后脱机成功,1例因上消化道出血死亡,2例自动出院。结论:双水平无创正压通气对有选择的COPD急性加重期并严重呼吸衰竭患者治疗疗效确切,它能迅速缓解病情,减少患者的气管插管和气管切开以及相应的并发症,提高生活质量。

Objective： To evaluate the value of non--invasive positive pressure ventilation（NIPPV） in the treatment of chronic obstructive pulmonary disease（COPD） with severe respiratory failure. Methods： Fourty-seven patients with acute exacerbation of COPD and severe respiratory failure complicated with different degree of conscious disturbances were enrolled from January 2006 to January 2008. These patients received assisted ventilation via face mask by bi - level noninvasive positive ventilator. The change of arterial blood gas, conscious state, outcome and complications of NIPPV were investigated. Results： NIPPV increased PaO2 significantly （P〈0.01）, declined PaCO2 significantly （P〈 0. 01） ,elevated blood pH （P〈0.01） in all but 6 patients who switched to invasive ventilation. Fourty-one patients recovered consciousness, separated from the ventilator and discharged successfully. Effectiveness of the treatment was 87. 23 % （41/47）. of the patients who switched to invasive ventilation, 3 were switched to sequential non--invasive mechanical ventilation and discharged, one died of upper gastrointestinal hemorrhage, and another gave up the treat- ment. Conclusion： Bilevel noninvasive positive ventilation is effective for the patients with acute exacerbation of COPD and severe respiratory failure. It can alleviation condition rapidly,decrease the rate of endotraeheal intubation, tracheotomy and Corresponding Complications to improve quality of life reasonably.