无创通气对急性生理学与慢性健康状况评分分值不同的慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者的疗效观察

Clinical study of noninvasive positive pressure in patients of COPD with type H respiratory failure and varying levels of APACHE II score

目的探讨无创双水平正压通气（BiPAP）对急性生理学与慢性健康状况评分（APACHEII）分值不同的慢性阻塞性肺疾病急性加重期（AECOPD）合并Ⅱ型呼吸衰竭患者的疗效。方法观察采用BiPAP通气治疗的60例AECOPD合并Ⅱ型呼吸衰竭患者，将其按APACHEⅡ分值水平分为低、中、高3组，比较各组BiPAP治疗失败率及治疗前后血气分析参数、血常规和C反应蛋白（CRP）的变化。结果治疗7天内高分值组无创通气治疗失败率最高（35％），各组未失败病例第7天血气指标、CRP均有显著改善（P〈0．05）。结论BiPAP通气治疗对AECOPD合并Ⅱ型呼吸衰竭患者的疗效肯定，其疗效的差异可考虑用APAHE11评分系统进行评估预测。

Objective To investigate the effet of noninvasive bi-level positive airway pressure （BiPAP） ventilation in the treatment of patients with type II respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease （AECOPD） and varying levels of acute physiology and chronic health evaluation II （ APACHE II ） score. Methods 60 cases of AECOPD with type II respiratory failure who received BiPAP were viewed. Divide the cases into three groups（low-moderate-high） by the level of APACHE II score. Comparison was then made within the three groups for failure rate of BiPAP and the changes of arterial gas analysis, hemogram and C-reactive protein （CRP）. Result Within 7 days of therapy the group of high-level of APACHE II score showed highest failuro rate of BiPAP（35 % ） , all the cases who had finished 7 days of BiPAP therapy showed significant improvement in blood gas analysis and CRP （P 〈 0.05 ）, no matter which group it belongs. Conclusion BiPAP is an effective method to treat patitents with AECOPD complicated by type II respiratory failure, and APACHE II might help to evaluate the disparity of treating effect of BiPAP.