无创通气治疗慢性阻塞性肺病并发Ⅱ型呼吸衰竭临床观察

Clinical reseachs of treatment of AECOPD with type Ⅱrespiratory failure by bilevel positive airway pressure ventilation via nasal/mouth mask

目的探讨经口/鼻面罩双水平气道正压通气(BiPAP)在慢性阻塞性肺病(COPD)急性发作期并发Ⅱ型呼吸衰竭中的临床应用价值。方法38例COPD急性发作并Ⅱ型呼吸衰竭患者分为两组,治疗组20例采用BiPAP常规治疗,对照组18例持续低流量吸氧,两组均给予常规治疗,比较治疗前、治疗2、24小时后两组同期动脉血气及呼吸频率、心率改变。结果治疗组治疗2小时后PaO2、pH值均较治疗前明显改善(P<0.05),治疗24小时后PaO2、PaCO2、pH值均较治疗前明显改善(P<0.05),呼吸频率、心率改变也较治疗前明显改善(P<0.05);治疗后治疗组PaO2、PaCO2改善与对照组比较,差异有显著性意义(P<0.05)。结论BiPAP是治疗慢性阻塞性肺气肿急性发作期并Ⅱ型呼吸衰竭经济、有效的方法。

Objective To evaluate the clinical effectiveness of bilevel positive airway pressure （BiPAP） ventilation via nasal/mouth mask in the treatment of acute exearbation of chronic obstructive pulmonary diseases （AECOPD） with type Ⅱ respiratory failure.Methods 38 AECOPD with type Ⅱ respiratory failure patients were divided into 2 groups.The 20 patients in test group were treated by conventional therapy plus BiPAP,while the 18 patients in control group were treated only by conventional therapy.Arterial blood gas,respiratory frequency and alteration in heart rate were compared before treatment,2 hours after treatment and 24 hours after treatment in the two groups.Results 2h after BiPAP treatment,PaO2,pH values in test group improved significantly than those before treatment （P 〈 0.05）.24h after treatment,PaO2,PaCO2,pH values,respiratory frequency and alteration in heart rate in test group improved significantly than those before treatment （P 〈 0.05）.Difference was significant （P 〈 0.05） between test group and control group in PaO2 and PaCO2 after treatment.Conclusions BiPAP ventilation is an effective method for AECOPD with type Ⅱrespiratory failure.