无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床疗效

Effect of noninvasive positive pressure ventilation on chronic obstructive pulmonary disease complicated with respiratory failure

目的：探讨无创正压通气治疗慢性阻塞性肺疾病（COPD）合并呼吸衰竭的临床治疗效果。方法：选择我院呼吸内科2009年5月至2010年12月收治的92例慢性阻塞性肺病合并呼吸衰竭患者,随机分为无创正压通气组和对照组,每组46例。无创正压通气组患者在药物治疗的基础上采用双水平正压通气（VPAPⅢ）,经口鼻面罩通气治疗。通气后24 h行血气分析。结果：无创正压通气组PaO2/FiO2显著较高（P〈0.05）,PaCO2显著较低（P〈0.05）。无创正压通气组住院天数317天,平均（7.9±5.1）天;3例因分泌物较多而改行气管插管通气,1例死亡。两组患者的住院时间、气管插管率差异均有统计学意义（P〈0.05）。死亡率差异无统计学意义（P〉0.05）。结论：采用无创正压通气治疗COPD合并呼吸衰竭具有无创、安全、有效的优点,值得临床上推广使用。

Objective： To explore the effect of noninvasive positive pressure ventilation on chronic obstructive pulmonary disease（COPD） complicated with respiratory failure.Methods： A total of 92 COPD patients with complication of respiratory failure admitted from May 2009 to December 2010 were selected,and randomly divided into noninvasive positive pressure ventilation group and control group by half.Patients in noninvasive positive pressure ventilation group were treated by VPAPIII ventilator and mask ventilation except for medicine treatment.Blood gas analysis was performed 24 h after ventilation.Results： PaO2/FiO2 increased significantly and PaCO2 decreased significantly in noninvasive positive pressure ventilation group（P〈0.05）.The hospitalization time was 3-17 d,averaged as（7.9±5.1）d.Three patients had intubation ventilation due to excessive secretion,and one was dead.There were significant differences in hospitalization time and the incubation rate between two groups（P〈0.05）,while the difference in mortality was not significant（P〉0.05）.Conclusions： Noninvasive positive pressure ventilation is invasive,safe and effect on COPD complicated with respiratory failure.It deserves extensive clinical application.