NPPV治疗AECOPD伴呼吸衰竭通气时间的临床观察

The Clinical Ovservation of Duration of Ventilation of NPPV to Treat AECOPD with Respiratory Failure

目的探讨无创正压通气(NPPV)治疗AECOPD伴呼吸衰竭最佳通气时间。方法将103例COPD急性加重(AECOPD)并发呼吸衰竭的患者随机分成两组(传统组与改良组),比较两组的心率、呼吸、血气分析,及患者的气管插管率,通气依从性,面罩皮肤压伤,腹胀发生,肺部感染。结果两组在NPPV治疗有效的患者中比较,心率、呼吸、血气分析结果明显好转;两组间比较,改良组在改善PaO2、PaCO2较传统组有效,在气管插管率、面罩压伤、腹胀、肺部院内感染发生率及通气依从性方面均优于传统组,比较差异均有统计学意义(P<0.05)。而在PH、心率、呼吸上比较基本相似,差异无统计学意义(P>0.05)。结论对于AECOPD合并Ⅱ型呼吸衰竭的患者,我们推荐与患者多沟通,尽可能每次NIPPV的通气时间控制在2小时以内。增加通气次数,提高患者的依从性,会提高救治成功率,减少气管插管率及并发症,我们认为值得推行。

Objective To investigate the optimized duration of ventilation of NPPV （noninvasive positive pressure ventilation） to treat AECOPD （acute exacerbations of chronic obstructive pulmonary disease） with RF （respiratory failure）. Methods To divide the 103 patients who had AECOPD with respiratory failure into two groups （traditional group and improved group） randomly. To compare the heart rate, respiration, blood gas analysis, trachea cannula rate, venting dependence, veil skin crush, abdominal distension occurrence and pul- monary infection of the two groups. Results The heart rate, respiration and blood gas analysis results were obviously improved in the effective NPPV treatment of the two groups. The improved group was more effective than the traditional group in the aspects of improving PaO2, PaCO2, and it had more advantages than the traditional group in the aspects of trachea cannula rate, veil skin crush, abdominal distension occurrence and pulmonary infection and venting dependence, the difference was statistically significant （P〈0.05）. but they were similar in the aspects of PH, heart rate, and respiration, the difference wasn＇t statistically significant （P〉O.05）. Conclusion For the patients with AECOPD with RF II, we advise that the duration of ventilation should be restrained in 2 hours. Increasing the frequency of ventilation and raising the dependence of patients can elevate remedy achievement ratio, reduce tracheal intubation rate and complication, so it＇s worth practising.