无创正压通气治疗慢性阻塞性肺疾病呼吸衰竭伴意识障碍的疗效观察

Effects of noninvasive positive pressure ventilation in the patients with respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease with conscious disturbances

目的观察无创正压通气(NPPV)治疗慢性阻塞性肺疾病(COPD)呼吸衰竭伴意识障碍患者的疗效。方法将入选的16例COPD呼吸衰竭伴意识障碍患者分为A组,16例意识障碍不明显患者分为B组。在常规治疗的基础上行双水平无创正压通气(BiPAP),动态观察治疗前后动脉血气、Glasgow昏迷评分、NPPV天数、住院天数、最高IPAP、NPPV成功率、住院病死率及不良反应情况。结果 A组NPPV成功率和住院病死率分别为68.75%(11/16)和18.75%(3/16),B组分别为81.25%(13/16)和12.5%(2/16),差异无统计学意义(P均>0.05)。A组最高IPAP均值较B组高6 cmH2O,且NPPV和总住院时间也较B组长3和7 d(P<0.05或P<0.01)。A组胃肠胀气和面部皮肤损伤较B组发生率高(68.75%比18.75%,25.0%比6.25%,P<0.05)。结论 NPPV对COPD呼吸衰竭伴意识障碍患者也有较好的疗效,意识障碍不是NPPV治疗的绝对禁忌症。

Objective To study the effects of noninvasive positive pressure ventilation（NPPV） on chronic obstructive pulmonary disease（COPD）patients with conscious disturbance to respriatory failure.Methods COPD patients with or without conscious distrubance to respiratory failure were treated by bi-level positive airway pressure（BiPAP）ventilation on base of routine therapy.There were 16 cases in group A with conscious disturbance and 16 cases in group B without conscious disturbance.Arterial blood gas（ABG）,Glasgow coma scale（GCS）,days of NPPV ventilation,days of prolonged hospital,maximal inhalational pressure（IPAP）,NPPV success rate,hospital mortality,and adverse effects were investigated.Results The NPPV success rate and hospital mortality were 68.75%（11/16）and 18.75%（3/16）in group A,which were comparable to those in group B[81.25%（13/16）and 12.5%（2/16）,P〉0.05].The patients in group A required higher maximal IPAP of an average of 6 cmH2O during NPPV and prolongde NPPV time by 3 days,prolonged hospital stay by 7 days,respectively（P〈0.05或P〈0.01）.The incidences of flatulence and the damage in face′s skin were higher in group A than group B（68.75% vs 18.75%,25.0% vs 6.25%,P〈0.05）.Conclusion COPD patients with conscious disturbance can respond well to NPPV,conscious disturbance is not the absolute contraindication of NPPV treatment.