无创正压通气治疗慢性阻塞性肺病急性加重并Ⅱ型呼吸衰竭的临床研究

The clinical study of feasibility of applying noninvasive positive pressure ventilation in treatment of patient with exacerbation of chronic pulmonary disease complicated with respiratory failure and encephalopathy

目的研究无创正压通气治疗慢性阻塞性肺病急性加重(AECOPD)合并Ⅱ型呼吸衰竭和肺性脑病患者的可行性。方法 61例慢性阻塞性肺病急性加重并肺性脑病患者随机分为无创正压通气治疗组(A组,n=32)和常规治疗组(B组,n=29)。两组均给予常规治疗,包括抗生素、解痉、平喘、止咳、祛痰、吸氧等治疗。A组在常规用药的基础上加用面罩双水平气道正压通气。首次气道正压通气持续时间需在2 h以上,至少间断使用3天。观察和对比两组患者入选后0、2、24和72 h的动脉血气分析、格拉斯哥昏迷评分[1]、气管插管率、住院病死率、平均住院日和平均住院费用等指标。结果两组入组时(0 h)上述指标均无显著性差异(P>0.05),具有可比性。治疗2 h后A组患者心率、呼吸频率、格拉斯哥昏迷评分、动脉二氧化碳分压较入组时均明显降低,PH、动脉血氧分压升高(P<0.05)。24及72 h上述指标持续改善。B组患者治疗2 h后上述指标有所改善,但无显著性差异(P>0.05)。治疗24h后B组气管插管率51.8%明显高于A组的9.4%(P<0.05)。A组的住院死亡率(3.1%)低于B组(17%),但缺乏统计学意义(P>0.05)。A组平均住院日(12±6)天,明显短于B组[(23±8)天,P<0.05]。A组平均住院费用(12145±2389)元,低于B组[(18218±5379)元,P<0.05]。结论 BIPAP无创呼吸机辅助通气治疗AECOPDⅡ型呼吸衰竭并肺性脑病疗效确切,能迅速改善AECOPD的气体交换,减少气管插管率和住院病死率,减少住院时间,降低住院费用。

Objective Objective To study the feasibility of applying noninvasive positive pressure ventilation（NIPPV） in treatment of patient with acute exacerbation of chronic pulmonary disease（AECOPD） complicated with respiratory failure and encephalopathy Methods 61 cases of AECOPD patients complicated with type Ⅱ respiratory failure and encephalopathy were randomly grouped into NIPPV group（group A,n=32） and routing therapy group（group B,n=29）.Both groups were given routine therapy that included antibiotics,bronchial-dilating agents,oxygen therapy and so forth.NIPPV was added besides the routine treatment in Group A and used not less than 2 hours at the beginning and afterwards discontinuously applied according to demand for at least 3 days.Arterial blood gas,Glasgow coma scale（GCS） of admission time,2 h,24 h,72 h were observed and compared and also intubation rate,death rate,hospitalization time and cost.Results There was no significant difference of the two group patients＇ condition at the time of admission（P〈0.05）.But a progressive improvement in HR,RR,GCS,PaO2 PaCO2,PH were observed at 2 h,24 h and 72 h in group A（P〈0.05）.There was a improvement of above index in group B at 2h but no significance compared with 0h（P〈0.05）.The intubation rate was 51.8% in group B that was much higher than group A（9.4%,P〈0.05）.The death rate of group A（3.1%） was lower than group B（17%）,P〉0.05.Comparing two groups,the average hospitalization time and cost were lower in group A（P〈0.05）.Conclusion NIPPV could be used in the treatment of AECOPD patient complicated with type Ⅱ respiratory failure and encephalopathy.