有无独立测压管的无创呼吸机治疗老年慢性阻塞性肺疾病急性加重期并Ⅱ型呼吸衰竭效果比较

Comparison of Curative Effects of Treatment of Acute Exacerbations of Chronic Obstructive Pulmonary Disease(AECOPD) and Type Ⅱ Respiratory Failure with Independent Pressure-testing Non-invasive Ventilator(NPPV)

目的探讨有独立测压管的双水平气道正压(bi-level positive airway pressure,BiPAP)无创呼吸机治疗老年慢性阻塞性肺疾病急性加重期(acute exacerbations of chronic obstructive pulmonary disease,AECOPD)合并Ⅱ型呼吸衰竭(呼衰)的效果。方法回顾性分析43例老年AECOPD合并Ⅱ型呼衰采用无创呼吸机治疗的临床资料,根据呼吸机有无独立测压管分为A、B两组,比较两组治疗24 h后无创通气的有效率及治疗前后动脉血气分析值的变化。结果无创呼吸机治疗24 h后,A组有效20例,有效率90.91%;B组有效16例,有效率76.19%,两组有效率比较差异有统计学意义(χ2=7.8400,P=0.0051);组间比较,两组治疗后的pH和氧分压(PaO2)值较治疗前升高,二氧化碳分压(PaCO2)较治疗前下降;治疗后A组pH7.42±0.03,PaO2(69.38±5.17)mmHg,PaCO2(63.39±7.54)mmHg,与B组比较差异均有统计学意义(P<0.01)。结论有独立测压管的BiPAP无创呼吸机治疗AECOPD合并Ⅱ型呼衰疗效确切,优于无独立测压管的BiPAP无创呼吸机。

Objective To discuss the clinical effects of the treatment of type Ⅱ respiratory failure of senile patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD） by independent pressure-testing BiPAP（bi-level positive airway pressure） non-invasive positive pressure ventilator.Methods 43 senile patients with AECOPD with type Ⅱ respiratory failure were divided into group A and group B according to whether the ventilator was equipped with independent pressure-testing pipe or not and were retrospectively analyzed.The efficiency of the two groups within 24 hours of the treatment of non-invasive ventilation and the changes of arterial blood gas analysis before and after ventilation were compared.Results 24 hours after the treatment with non-invasive ventilator,20 patients from Group A showed improvement and the efficiency rate was 90.91%;16 patients from group B showed improvement and the efficiency rate was 76.19%.The efficiency difference between the two groups was statistically significant（χ2=7.8400,P=0.0051）;intra-group comparison indicated that,after the treatment,the value of pH and PaO2 of both the two groups increased,while the value of PaCO2 decreased.After the treatment,pH 7.42±0.03,PaO2（69.38±5.17）mmHg,PCO2（63.39±7.54） mmHg of group A showed significant difference when compared with that of group B（P0.01）.Conclusion The curative effects of the treatment of AECOPD with type Ⅱ respiratory failure by independent pressure-testing BiPAP non-invasive positive pressure ventilator are significant.The one with independent pressure-testing is superior to that without it.