老年COPD患者并发呼吸衰竭的临床治疗探讨

Elderly patients with COPD concurrent clinical treatment of respiratory failure are discussed

目的探讨老年慢性阻塞性肺疾病(COPD)并发呼吸衰竭的临床治疗方法及效果。方法选择笔者所在医院自2007年6月～2009年12月收治的老年COPD并发呼吸衰竭患者77例,随机分为观察组和对照组,观察组39例,对照组38例,两组患者均经常规处理,对照组给予传统机械通气,观察组给予无创正压通气(NPPV),动态观察两组患者治疗后神志变化、动脉血气分析(12h、24h、72h)、并发症以及不良反应,并进行对比分析。结果观察组与对照组比较,无创正压通气(NPPV)治疗后,患者PaCO2明显降低(P<0.05),PaO2明显升高(P<0.05),pH明显升高(P<0.01),具有统计学意义,其中4例患者因病情发生变化改用传统与无创序贯机械通气治疗,1例患者死亡,其余患者均好转出院。结论对老年COPD并发呼吸衰竭患者给予无创正压通气治疗,合理地调整参数,准确掌握吸气支持压力,尤其对不同程度的神志障碍者,可以得到满意的治疗效果。

Objective Explore elder patients with chronic obstructive pulmonary disease（COPD）concurrent respiratory failure clinical treatment methods and effects.Methods Choose our hospital all June 2007 to December 2009,drug-induced elderly patients with COPD concurrent respiratory failure 77 cases were randomly divided into trial group and control group,the observation group 39 cases and control 38 cases,two groups of patients were given by conventional treatment group and the traditional mechanical ventilation,the observation group gives noninvasive positive pressure ventilation（NPPV）,dynamic observe both groups of patients after treatment was change,arterial blood gas analysis（12 h and 24 h,72 h）,complications and adverse reactions, and are compared and analyzed.Results The observation group compared with controls, noninvasive positive pressure ventilation（NPPV）therapy,the patient PaCO2 decreased obviously（P0.05）,PaO2 significantly increased（P0.05）,pH increased significantly（P0.01）,a statistically significant,including four patients because of illness change convert tradition and noninvasive sequential mechanical entilation,1 patients died,the rest of the patients were improved discharge.Conclusion In elderly patients with COPD concurrent respiratory failure to noninvasive positive airway pressure treatment,rationally adjust the parameters,accurately mastering inspiratory support stress,particularly for different degrees of mind disabilities, and can obtain satisfactory therapeutic effect.