COPD急性加重导致严重呼吸性酸中毒时无创正压通气的应用

Application of noninvasive positive pressure ventilation in patients with severe respiratory acidosis due to acute exacerbation of COPD

目的 对比无创正压通气（NPPV）对慢性阻塞性肺疾病（COPD）急性加重导致轻度呼吸性酸中毒与严重呼吸性酸中毒的疗效.方法 对比人选COPD急性加重导致轻度呼吸性酸中毒（pH 7.25～7.35）组患者和严重酸中毒（PH〈7.25）组患者NPPV2小时后pH值和PaCO2的变化、24小时后pH值恢复正常的人数、总的NPPV治疗时间和住院天数.结果 轻度酸中毒组和严重酸中毒组相比,NPPV 2小时后pH变化值分别为（0.04±0.01）和（0.06±0.03）,PaCO2分别为（14.3±7.4）mmHg和（18.1±11.2）mmHg,改善程度相似（P〉0.05）.两组患者NPPV 24小时后pH值恢复正常比率（分别为65.9%和59.5%）、NPPV应用时间分别为（103±8.1）小时和（106±6.6）小时,住院天数分别为（13±2.7）天和（15±4.1）天及NPPV失败率（分别为13.6%和19.0%）也无差异（P〉0.05）.结论 无创正压通气治疗对COPD急性加重导致严重呼吸性酸中毒的患者是有效的.

Objective To compare the effect of noninvasive positive pressure ventilation （NPPV） in severely respiratory acidotic with mildly respiratory acidotic patients with acute exacerbation of chronic obstructive pulmonary disease （COPD）.Methods Comparison of NPPV in enrolled patients with acute exacerbation of COPD with mild（pH 7.25 ～ 7.35） or severe（pH〈7.25） respiratory acidosis on changes of pH and PaCO2 after 2 h of NPPV, ratio of patients to normalise pH after 24h of NPPV, duration of NIV treatment, length of stay in hospital. Results 44 with mild（pH 7.25 ～ 7.35） respiratory acidosis and 42 severe（pH〈7.25） respiratory acidosis. Compared with the mildly acidotic group, the severely acidotic group took a similar improvements for pH （0.04 ± 0.01）vs （0.06 ± 0.03） respectively, P=0.41 and PaCO2 （14.3 ± 7.4） vs （18.1 ± 11.2） mmHg respectively,P=0.34 ）after 2 h of N PPV, with similar ratio of patients to normalise pH after 24h of NPPV （ 65.9% and 59.5% respectively,P=0.65）, with similar duration of N PPV treatment （103 ± 8.1） vs （106 ± 6.6）h, respectively, （P=0.74） and hospital length of stay （13 ± 2.7） vs （15 ± 4.1）days, respectively, P=0.53. Conclusion NPPV is effective in the treatment of patients with severe respiratory acidosis due to acute exacerbation of COPD.