无创正压通气治疗慢性阻塞性肺疾病Ⅱ型呼吸衰竭患者的临床分析

Noninvasive positive pressure ventilation to treat acute exacerbations chronic obstructive pulmonary disease

目的探讨无创正压通气(NIPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效及不良反应。方法将79例慢性阻塞性肺疾病急性加重期的患者随机分为对照组(n=37)和无创正压通气治疗组(即NIPPV治疗组,n=42),对照组只给予常规治疗,NIPPV治疗组在常规治疗基础上给予鼻(面)罩双水平气道正压BiPAP辅助通气。比较两组患者治疗前、治疗后2h、治疗后24h动脉血气水平和临床征象变化;比较两组住院时间及治疗有效率。结果 NIPPV组治疗2h后,血气分析各项指标有明显改善,治疗后24h各项指标继续好转,对照组治疗2h后血气结果变化不明显,24h后各指标改善明显,但改善幅度无NIPPV组明显(P<0.05);NIPPV治疗组住院时间短于对照组(P<0.05),治疗有效率高于对照组(P<0.05)。结论 NIPPV是治疗慢性阻塞性肺疾病急性加重期的一种有效手段,可快速改善患者病情,提高治疗有效率,缩短住院时间。

Objective To investigate the clinical effect and the undesirable effect of noninvasive positive pressure ventilation （NIPPV） on patients with acute exacerbations chronic obstructive pulmonary disease （AECOPD）.Methods 79 patients with AECOPD were randomly divided into control group （n=37） and NIPPV therapy group （n=42）.The patients of control group have conventional therapy,the patients of NIPPV therapy group was treated with conventional method and noninvasive positive pressure ventilation using BiPAP.Arterial blood gas and the clinical situation at before and 2,24 hours after the therapy were recorded and analyzed,length of hospital stay and the effective rate between the two groups were compared respectively.Results In the NIPPV group,there was a significant improvement of PaO2 and pH at 2 hours and 24 hours after the therapy,while PaCO2 descended.In the control group,PaCO2 and pH did not improve significantly at 2 hours after the therapy,but there was a significant improvement of PaO2 at 24 hours after the therapy.However,the improvement was not as significant as the NIPPV group （P0.05）.The length of hospital stay in the NIPPV group was markedly decreased than that in the control group（P0.05）.The effective rate in the NIPPV group was markedly higher than that in the control group（P0.05）.Conclusions Noninvasive positive pressure ventilation was effective to treat AECOPD,and can improve patients’ condition quickly,improve effective rate and shorten the hospital stay.