BiPAP无创通气对COPD并重度呼吸衰竭的疗效

Clinical investigation of bi-level non-invasive positive pressure ventilation in treatment for patients with chronic obstructive pulmonary disease and severe respiratory failure

目的评估无创正压通气(NIPPV)在治疗慢性阻塞性肺疾病(COPD)并重度呼吸衰竭或伴有不同程度意识障碍患者中的价值,为更好地选择NIPPV的临床应用适应症提供依据。方法对79例COPD并重度呼吸衰竭或伴有不同程度意识障碍的患者使用BiPAP呼吸机辅助通气,动态观察NIPPV治疗前和治疗后2～4 h、24 h、3 d及5 d动脉血气、意识、治疗后患者的转归、NIPPV的不良反应及并发症。结果 79例患者经NIPPV治疗,与治疗前比较,68例患者PaCO_2明显降低、pH升高,均脱机出院,有效率达86.1%;7例改为有创通气,4例放弃治疗。结论 BiPAP无创通气是治疗COPD并重症呼吸衰竭或伴有不同程度意识障碍患者的有效手段;意识障碍并非无创通气的绝对禁忌。

Objective To evaluate the value of non - invasive positive pressure ventilation （NIPPV） in the treatment of chronic obstructive pulmonary disease（COPD） with severe respiratory failure or disturbed consciousness. Methods 79 patients with acute exacerbation of COPD and severe respiratory failure complicated or with different degree sive positive of conscious disturbances were enrolled. Subjects received assisted ventilation by bi - level noninvaventilator. The change of arterial blood gas, conscious state , outcome and complications of NIPPV were investigated. Results NIPPV declined PaCO2 significantly, elevated blood pH in 68 patients but 7 subjects who switched to invasive ventilation, 4 gave up the treatment. Conclusion Bi - level noninvasive positive ventilation is a effective therapy for the patients with acute exacerbation of COPD and severe respiratory failure or disturbed consciousness. The conscious disturbances is not the contraindication for NIPPV.