无创正压通气在慢性阻塞性肺疾病急性加重并发呼吸衰竭中的应用及影响治疗因素分析

Clinical application of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease and analysis of the failure risk factors

目的:观察无创正压通气(noninvasive positive pressure ventilation,NPPV)对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并呼吸衰竭的临床疗效及影响因素。方法:COPD并发Ⅱ型呼吸衰竭144例均分为两组,常规组给予常规治疗;NPPV组给予常规治疗加用无创通气(Vision无创呼吸机);记录患者年龄、COPD病史,治疗前及治疗后2h、24h的心率、呼吸频率、收缩压、舒张压、体温、血白细胞计数、血钠、动脉血气(pH、PaCO2、PaO2)、氧合指数(PaO2/FiO2)以及格拉斯哥昏迷评分等14项生理指标,分析可能影响NPPV的血气分析、生理指标等因素。结果:NPPV组治疗后2h,与治疗前比较,PaO2、pH值即有显著上升,PaCO2下降,24h后各指标继续改善;而常规组2h后血气分析结果改善不明显,24h后各指标显著改善,但改善幅度均低于NPPV组(P<0.01);NPPV组治疗失败率及需气管插管率均低于常规组(P<0.05);高龄、重度呼吸性酸中毒、重度PaCO2升高以及昏迷者尤其2h后无明显改善者,NPPV治疗失败的风险增加。结论:NPPV是治疗COPD合并Ⅱ型呼吸衰竭一种有效手段。高龄、重度呼吸性酸中毒、重度CO2潴留者NPPV治疗2h无效者及时气管插管行有创通气。

Objective：To investigate the clinical effect of noninvasive positive pressure ventilation（NPPV） on patients with chronic obstructive pulmonary disease （COPD）complicated with respiratory failure, and the factors affecting the results. Methods：One hundred and forty-four patients with COPD complicated with respiratory failure were divided into conventional therapy group and NPPV therapy group. The patients＇ age, COPD history, heart rate at 2,24 hours before and after the therapy, respiratory rate, systolic and diastolic pressure, body temperature, blood white cell counting, blood sodium, arterial blood gas （ pH, PaCO2, PaO2 ） , oxygenation index （ PaO2/ FiO2 ） and Glasgow coma score were recorded and analyzed. Results： In the NPPV group, there was a significant improvement of PaO2 and pH at 2 hours after the therapy, while PaCO2 descended. The other indexes further improved at 24 hours after the therapy（P 〈 0.05 ）. In the conventional therapy group, PaCO2 and pH did not improve significantly at 2 hours after the therapy（ P 〉 0.05 ） but there was a significant improvement of PaO2 at 24 hours ＇after the therapy（ P 〈 0.05 ）, anyhow, the improvement was not as significant as the NPPV group（ P 〈 0.01 ）. The rate of failed treatment and end tracheal intubation in the NPPV group was markedly lower than that in the conventional therapy group（ P 〈 0.05 ）. Aged patients ,patients with severe respiratory acidosis, high PaCO2 or in a coma had a higher risk of failure. Conclusions ： Noninvasive positive pressure ventilation is effective for patients with COPD complicated with respiratory failure. Aged patients and patients with serious respiratory acidosis or heavy CO2 retention should resort to tracheal intubation if NPPV failed to act.