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双水平无创正压通气在Ⅱ型呼吸衰竭中的应用 被引量:7

Application of non-invasive positive pressure ventilation in type-Ⅱrespiratory failure
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摘要 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.
出处 《陕西医学杂志》 CAS 2011年第1期37-39,共3页 Shaanxi Medical Journal
关键词 肺疾病 慢性阻塞性/并发症 呼吸功能不全/治疗 正压呼吸 @双水平无创正压通气 Pulmonary disease chronic obstructive/complication Respiratory insufficiency/therapy Positive-pressure respiration @Non-invasive positive pressure ventilation
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参考文献5

  • 1British thoracic society standards of care. Non-in-vasive ventilation in acute respiratory failure[J]. Thorax, 2002, 57(3):192-211.
  • 2Alejandro C, Arroliga MD. Non-in vasive positive pressure ventilation in acute respiratory failure: Does it improve outcomes. Clevel and Clinic Journal of Medicine, 2001,68(8): 677-680.
  • 3钮善福.机械通气治疗呼吸衰竭(上)[J].临床急诊杂志,2002,3(6):251-253. 被引量:3
  • 4Lightowler JV, Wedzicha JA, Elliott MW, et al. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease:cocbrane systematic review and meta-analysis. BMJ, 2003, 326 (7382) :185- 189.
  • 5廖秀清,李琦,林科雄,张巧,王长征,钱桂生.早期无创正压机械通气治疗慢性阻塞性肺病合并呼吸衰竭的随机对照试验[J].第三军医大学学报,2004,26(8):739-741. 被引量:8

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