无创正压通气在COPD呼吸衰竭患者救治中撤机方法探讨

A study of different ways to wean noninvasive positive pressure ventilation in treatment of COPD with respiratory failure

目的:探讨无创正压通气(NPPV)治疗慢性阻塞性肺疾病(COPD)并发Ⅱ型呼吸衰竭时,不同的撤机方法对临床效果的影响。方法:将63例经持续应用NPPV治疗的COPD并发呼吸衰竭的患者,达到统一制定的撤机标准后,随机分为3组,分别采用直接停用的方法(直停组)18例;逐步减少通气时间的方法(减时组)24例;逐步减少吸气压力的方法(减压组)21例。结果:直停组、减时组和减压组的撤机成功率分别为38.9%(7例)、62.5%(15例)和42.8%(9例),减时组的撤机成功率最高(P<0.05)。另外减时组和减压组中自动脱机的患者分别为1例和4例。结论:采用逐步减少NPPV时间的方法撤机,可以获得较高的成功率。逐步减少吸气压力的方法影响了患者的依从性,对撤机的效果产生不利的影响。

Objective：To study the influence of different ways of weaning noninvasive positive pressure ventilation （NPPV） in the treatment of chronic obstructive pulmonary disease （COPD） with type Ⅱ respiratory failure.Methods：Sixty-three patients suffering from COPD with the type Ⅱ respiratory failure, who needed treatment by continuous NPPV, between Feb.2004 and Nov.2008 were enrolled in the study.They were randomly divided into three groups,the patients in the first group （18 cases） were weaned NPPV directly,the patients in the second group （ 24 cases ） were decreased the treatment-time gradually and in the third group （21 cases ） were decreased the aspiration pressure gradually. Results：The weaning success rates of the first group,the second group and the third group were 38.9%, 62.5% and 42.8% respectively.Conclusion ：Decreasing the treatment-time by NPPV gradually makes weaning easily.