无创正压通气治疗慢性阻塞性肺病急性加重期呼吸衰竭临床研究

Clinical Research of Noninvasive Positive Pressure Ventilation on Respiratory Failure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的观察无创正压通气（NIPPV）治疗慢性阻塞性肺病（COPD）急性加重期合并呼吸衰竭患者的临床疗效。方法 52例COPD患者随机分为治疗组（26例）和对照组（26例）,给予常规抗感染、解痉、平喘、止咳、化痰、吸氧、对症支持治疗等处理,在上述治疗基础上加用无创正压通气治疗,采用美国伟康BiPAP Vi-sion、S/T D30呼吸机,压力支持/压力控制（S/T）模式,经口鼻面罩辅助通气,时间3 h/次,4~5次/d,吸气压力（IPAP）10~16 cmH2O,呼气压力（EPAP）4~6 cmH2O,备用频率12次/min。结果治疗组在无创正压通气治疗72h后,PaCO2降低,PaO2明显升高,呼吸频率下降,且肺功能明显改善,与治疗前及对照组相比,P〈0.05,差异有统计学意义。结论双水平实用无创正压通气（NIPPV）可明显改善慢性阻塞性肺病急性加重期合并呼吸衰竭患者的血气、肺功能及临床症状,是一种有效的治疗手段。

Objective To observe the clinical effect of non-invasive positive pressure ventilation（NIPPV） in the treatment of chronic obstractive pulmonary disease（COPD） combined with respiratory failure atacute exacerbation phase.Methods 52 patients with COPD with respiratory failure were devided into the intervention group（26cases）and control group（26cases）.The control group was given antiinfection,eliminating phlegm,relieving asthma,hormone,low-flow oxygen and supply treatment,the intervention group were treated with BiPAP ventilation,in addition to above routine treatment and oronasal-assisted ventilation（BiPAP Vision,Respironics S/T D30,USA）with an average ventilation time of 6 to 8 hours per day Ventilation parameters were prescribed as inspiratory pressure of 12 to 16 cm H2O,expiratory pressure of 4 cm H2O and back-up respiratory frequency of 12 times per minute.Results compared before treatment and comparison group.Therapy group showed improving Pa02,Lowering PaCO2,respiratory rate,FEV1%,FEV1∕FVC%,were improved after NIPPV.（P0.05） for 72hours.Conclusions NIPPV can effectively improve the blood gas analysis index and clinical symptoms of COPD combined with TypeⅡrespiratory failure atacute exacerbation phase.