双水平无创正压通气在Ⅱ型呼吸衰竭中的应用

Application of non-invasive positive pressure ventilation in type-Ⅱrespiratory failure

目的:探讨双水平气道正压通气(BiPAP)治疗慢性阻塞性肺疾病并发II型呼吸衰竭的疗效。方法:在常规药物治疗的基础上,应用无创正压通气(BiPAP)治疗COPD并发II型呼吸衰竭40例,观察并比较治疗前后患者临床状况、生命体征(呼吸频率、心率、血压)及血气分析指标(PO2、PCO2)的变化和通气相关的不良反应等。结果:经机械通气治疗后,有32例临床状况明显改善(神志好转、呼吸频率、明显减慢、呼吸困难减轻);8例治疗无效者病情恶化(5例死亡,2例自动出院,1例改为接受气管插管行有创通气治疗),总有效率80%。通气治疗前、后呼吸频率分别为24±4次/min与20±4次/min,两者有显著性差异(P<0.05);通气治疗前、后心率分别为110±17次/min与91±22次/min,亦有显著性差异(P<0.05);血压治疗前为124±17/75±11mmHg,治疗后为120±17/72±9mmHg,两者无显著性差异(P>0.05)。通气前、后患者PCO2水平分别为76±20mmHg与63±17mmHg,两者有显著性差异(P<0.05);通气前经常规治疗缺氧初步改善(PO2>60mmHg)的26例患者中,通气前、后PO2分别为81±24mmHg与74±20mmHg,两者无显著性差异(P>0.05);但在通气前经常规治疗后仍PO2<60mmHg的14例患者中,PO2通气前、后为分别为44±11mmHg与64±19mmHg,治疗前、后比较有显著性差异(P<0.05)。不良反应:5例出现不同程度腹胀,7例口干,2例不能耐受面罩,2例出现呼吸机依赖,所有病例均无气压伤、院内感染或呼吸机相关性肺炎等并发症发生。结论:双水平正压通气应用于慢性阻塞性肺病并发II型呼吸衰竭患者,能缓解症状,稳定生命体征,有效改善血气指标。且相关并发症少。

Objective： To evaluate the efficacy of non-invasive positive pressure ventilation in COPD patients with type-Ⅱrespiratory failure,and get some experience to guide clinic practice.Methods： 40 cases of COPD patients with type-Ⅱrespiratory failure were retrospectively analysed.Based on conventional medical therapy,all the cases received non-invasive bi-level positive airway pressure ventilation.The changes of symptoms,arterial blood gas analyses,respiratory rate,heart rate and blood pressure were observed before and after treatment,then the comparisoins of these results were made.Results ： In the 40 cases,these were 32 cases acquired obvious symptomatic improvement（higher level of consciousness,respiratory rate stepped down,dyspnea lessened）and got discharge;the other 8 cases deteriorated（5 died,2 discharged automatically,1 received tracheal intubation for invasive ventilation）.The total efficacy rate was 80% for these patients,the respiratory rate before and after ventilation were24±4/min and20±4/min,the heart rate were110±17/min and91±22/min respectively.There were significant difference in both,P〈0.05.However,blood pressure of these patients before and after ventilation were124±17/75±11mmHg and120±17/72±9mmHg,there was no significant difference,（P〈0.05）.The patients＇ PCO2 before and after the ventilation were76±20 mmHg and63±17mmHg respectively,there was a significant difference（P〈0.05）.The PO2 before and after ventioation for those 26 patients whose PO260mmHg after received conventional medical therapy were81±24mmHg and 74±20 mmHg respectively,and for those 14 patients whose PO260mmHg after received conventional medical therapy were44±11mmHg and64±19mmHg respectively.The difference was obvious in the latter（P〈0.05）,but not in the former（P〈0.05）.During ventilation treatment,the ventilation associated complications included gastric distention occurred in 5 patients,dry mouth in 7 patients,poor tolerated in 2 patients,ventilator-depending in 2 patients.None of 40 patients suffered barotraumas,hospital acquired infection or ventilation associated pneumonia and so on.Conclusion ： The application of non-invasive BiPAP ventilation in COPD patients with type-Ⅱrespiratory failure can improve symptoms and the blood gas indices,stabilize vital sign,and has less complications which demonstrate that non-invasive BiPAP ventilation is an effective,well tolerated and safe,convenient approach for those patients.