无创正压通气治疗中重度肺性脑病临床效果评价

Evaluation of noninvasive positive pressure ventilation on middle to severe degree of hypercapnic coma

目的评价无创正压通气（NIPPV）应用于中重度肺性脑病患者的治疗效果。方法将79例肺性脑病患者依格拉斯哥昏迷评分（GCS）分为8分〈GCS≤12分的中度肺性脑病组（A组）和GCS≤8分的重度肺性脑病组（B组），并给予无创通气治疗。结果①总成功率79．75％，其中A组80．85％，B组78．12％。②两组患者均在治疗1h后，GCS、PaCO2明显改善，PaO2／FiO2、pH、RR和HR于治疗2h后明显改善。③失败组患者较成功组患者有更多的并发症发生率、较高的急性生理和慢性健康评分（Acute Physiology And Chronic Health Evaluation，APACHE-Ⅱ评分）；A组患者以不耐受NIPPV治疗、面罩漏气为主；B组以血液动力学不稳定、气道保护能力差为主。④Logistic分析结果提示APACHE-Ⅱ评分、治疗1h PaCO2和GCS评分、2h的RR、血液动力学状态、面罩漏气状况及气道保护能力与治疗成败存在相关性。结论①无创通气治疗肺性脑病是安全、有效的。②治疗后2h患者的反应可以初步判断NIPPV疗效。③A组治疗过程中应关注患者主观的感受或面罩严密性；B组则需要关注患者的血液动力学情况或气道的保护能力。④APACHE-Ⅱ评分、无创通气治疗后1h的GCS评分和PaCO2、2h后的RR及面罩漏气、血液动力学状态、气道保护能力可以预测中重度肺性脑病患者无创通气治疗的成败。

Objective To evaluate the effect of non-invasive positive pressure ventilation（NIPPV） on middle to severe degree of hypercapnic coma. Methods There were 79 patients enrolled and were classified into two groups as middle hypercapnic coma group （8〈 G GCS≤12）（group A）and severe hypercapnic coma group（GCS≤8）（group B）according to Glasgow Coma Scale（GCS） ;and received NIPPV therapy. Results （1）There were 79 patients enrolled and the successful rate was 79.75%, 38 cases in group A （ 80.85 %）, 25 cases in group B （ 78.12% ） respectively （ P 〉0.05 ）. （2） GCS, PaCO2 had been improved after the 1 h posttherapy（ P 〈0.05）both in group A and group B; other variables such as PaO2/ FiO2,pH,RR and HR showed significant improvement after 2 h post therapy （P 〈 0.05）. （3）The complication（ P 〈0.05）and the acute physiology and chronic health evaluation（APACHE-Ⅱ ）score（ P 〈 0.01） was higher in failure group than in success group;the main reasons of failure were the intolerance to NIPPV and mask leakage in group A, whereas hemodynamic instability and the poor ability of airway protection in group B（ P 〈0.05）. （4）Logistic analysis showed that there were great significant relation between APACHE-Ⅱ score, GCS and PaCO2 after the 1 h posttherapy, RR after the 2 h posttherapy, hemodynamic state,mask leakage,and the ability of airway protection（ P 〈0.05）. Conclusions （1）NIPPV could be used on the patients with hypercapnic coma secondary to AECOPD safely and effectively. （2）The response of the patients to NIPPV therapy after 2 h may predict the result of NIPPV therapy. （3）The patients,subjective feeling,mask leakage in group A and hemodynamic condition and airway protection in group B should be pay more attention to. （4）Logistic analysis indicate that the APACHE-Ⅱ score, GCS after the 1 h posttherapy,RR after the 2 h posttherapy,mask leakage,hemodynamic state and the ability of airway protection could predict the effect of NIPPV therapy on middle to severe degree of hypercapnic coma.