无创正压通气治疗COPD急性加重合并重度Ⅱ型呼吸衰竭的疗效观察

Effectiveness of Noninvasive Positive Pressure Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated with Severe Type Ⅱ Respiratory Failure

目的探讨无创正压通气(NPPV)治疗COPD急性加重(AECOPD)合并重度Ⅱ型呼吸衰竭的临床疗效。方法回顾分析2008年1月至2009年6月期间因AECOPD合并重度Ⅱ型呼吸衰竭住院接受NPPV治疗的37例患者(NPPV组),同期住院但未接受NPPV治疗的类似患者42例作为对照组。比较两组患者治疗前后的动脉血气、住院天数及治疗插管率。结果治疗后两者患者动脉血气pH、PaCO2、PaO2均较治疗前明显改善(P<0.01,P<0.05)。与对照组比较,NPPV组动脉血气pH、PaCO2、PaO2改善更明显(P<0.05)。NPPV组的平均住院时间比对照组缩短[(10±5)d比(19±4)d,P<0.05],气管插管率显著下降(2.7%比16.7%,P<0.05)。结论对于AECOPD合并重度Ⅱ型呼吸衰竭患者,NPPV可以改善通气,缩短患者住院天数,降低气管插管率。

Objective To investigate the effectiveness of noninvasive positive pressure ventilation （NPPV） in acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated with severe type Ⅱ respiratory failure.Methods 37 patients who were admitted from January 2008 to June 2009 due to AECOPD complicated with severe type Ⅱ respiratory failure and had received NPPV therapy were enrolled as a NPPV group.Another similar 42 cases who had not received NPPV therapy served as control.All subjects received standard medication therapy according to the guideline.Arterial blood gases before and after treatment,the duration of hospitalization and intubation rate were observed.Results The arterial pH,PaO2,and PaCO2 improved significantly after treatment as compared with baseline in both groups （P0.05）.Compared with the control group,the average duration of hospitalization was significantly shorter （10±5 vs.19±4 days,P0.05） and the intubation rate was significantly lower （2.7% vs.16.7%,P0.05） in the NPPV group.Conclusion The use of NPPV in AECOPD patients complicated with severe type Ⅱ respiratory failure is effective in improving arterial blood gases,reducing the duration of hospitalization and intubation rate.