无创通气与有创通气在慢性阻塞性肺疾病加重期患者中的疗效观察

Efficacy of invasive and noninvasive ventilation in the treatment of chronic obstructive pulmonary disease complicated with type II respiratory failure

目的 观察无创通气与有创通气治疗慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）加重期的临床疗效.方法 80例COPD加重期患者,按照入科时的PaCO2水平,应用分层随机化法分为无创组和有创组各40例,两组均给予常规基础治疗.当患者需要机械通气时,无创组给予无创呼吸辅助,治疗效果不佳时更换为有创通气;有创组给予有创呼吸辅助.观察指标：两组患者治疗6 h、24h及7 d后pH、PaO2、PaCO2变化;两组患者VAP发生率、插管率、死亡率、住ICU时间和住院费用.结果 治疗后两组血气分析结果（pH、PaO2、PaCO2）均有显著改善,且有创组改善程度优于无创组,但两组间比较差异无统计学意义（均P＞0.05）;两组患者死亡率差异无统计学意义（P＞0.05）;无创组插管率、住ICU时间、呼吸机相关性肺炎（ventilator-associated pneumonia,VAP）发生率、住院费用较有创组明显降低,差异有统计学意义（P＜0.05）.结论 无创通气治疗COPD加重期患者无创伤、疗效确切,缩短住院时间,降低住院费用和VAP发生率,能使部分患者免于气管插管,值得临床广泛应用.

Objective To observe the clinical therapeutic efficacy of noninvasive ventilation and invasive ventilation in the treatment of chronic obstructive pulmonary disease （ COPD ） complicated with type II respiratory failure. Methods A total of 80 patients with COPD complicated with type II respiratory failure were randomly and equally divided into noninvasive ventilation group and invasive ventilation group respectively. The patients in both the two groups were given other therapies routinely. Results The symptoms were relieved significantly in both groups. The results of blood gas analysis, APACHE II and 28 day survival rate were improved in both the two groups. The ICU stay, use of mechanical ventilation, the rate of ventilation - associated pneumonia and the hospitalization cost were decreased significantly in the noninvasive ventation group. Conclusion Noninvasive ventilation in the treatment of COPD combined with type II respiratory failure could rapidly correct hypoxia and carbon dioxide retention, relieve clinical symptoms, shorten the hospital stay and decrease the hospital cost and the occurrence of ventilation - associated pneumonia.