无创双水平气道正压通气改善低氧高碳酸血症的临床应用

The clinical application of non-invasive bi-level positive airway pressure mechanical ventilation in treatment of hypoxia and hypercapnia

目的:探讨无创双水平气道正压通气(bi-level positive airway pressure,BiPAP)在低氧高碳酸血症治疗中的临床应用价值。方法:选择62例低氧血症或者同时合并高碳酸血症的患者,分别为慢性阻塞性肺疾病(chronic obstructive pulmonarydisease,COPD)和阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS),分为A组和B组,根据患者具体情况实施治疗措施,其中A组32例进行无创BiPAP,B组呼吸兴奋剂治疗。观察2组心率、呼吸频率和血气分析的变化情况。结果:A组低氧血症或者同时合并高碳酸血症的症状得到改善,1例改为气管插管有创机械通气。B组4例需气管插管有创机械通气,1例多器官衰竭病死。A组治疗后心率、呼吸频率和血气分析均优于B组(P<0.01)。结论:无创BiPAP能够改善患者的低氧血症和高碳酸血症,降低心率和呼吸频率,缓解病情,临床效果显著,是一种简便、有效、安全、可靠且易被患者接受的治疗方法。

Objective： To investigate the role of non-invasive bi-level positive airway pressure mechanical ventilation （BiPAP）in treatment of hypoxia and hypercapnia in the clinical application. Methods：Sixty-two patients complicated with hypoxia and hypercapnia including chronic obstructive pulmonary disease （COPD） and obstructive sleep apnea hypopnea syndrome （OSAHS） were selected and divided into group A and group B. Thirty-two patients in group A were underwent non-invasive BiPAP mechanical ventilation, others in group B were treated with respiratory stimulant. Heart rate, respiratory rate and blood gas analysis were observed. Results：The symptom of patients in group A with hypoxia and hypercapnia had been improved by non-invasive BiPAP mechanical ventilation. Only 1 patient needed invasive mechanical ventilation by endotracheal intubation. While in group B, 4 patients required endotracheal intubation and invasive mechanical ventilation, 1 patient was dead because of multiple organ failure. After treatment, the improvement of heart rate, respiratory rate and blood gas analysis in group A were better than in group B （ P 〈 0. 05 ）. Conclusions ： Non-invasive BiPAP mechanical ventilation can improve hypoxia and hypercapnia, decrease heart rate and respiratory rate, which plays a good therapeutic effect. BiPAP is a simple, effective, safe, reliable way, and susceptible to remission of disease.