无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭疗效观察

目的探讨无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的疗效,进一步指导临床治疗。方法选择2007年2月～2010年2月收治的慢性阻塞性肺疾病疾病合并II型呼吸衰竭患者共40例,随机分为呼吸机观察组(20例)和对照组(20例)。两组都给予吸氧治疗,抗感染,祛痰,支气管舒张剂,呼吸兴奋剂,糖皮质激素,纠正水电解质酸碱失衡,营养,支持等治疗。观察组在上述治疗基础上加用BiPAP无创呼吸机,对比两组治疗前后心率、呼吸频率、血气分析变化。结果观察组患者经治疗后pH=(7.39±0.04),PCO2为(54±14)mmHg,PO2为(47±6)mmHg,SO2为(97.6±2.3)%,RR(98±14)次/min,HR(23±5)次/min,而对照组患者经治疗后pH=(7.35±0.04),PCO2为(64±15)mmHg,PO2为(55±8)mmHg,SO2为(90.3±5.6)%,RR(114±16)次/min,HR(28±5)次/min,观察组治疗效果明显优于对照组(均P<0.05)。观察组住院时间短于对照组(P<0.05),且住院费用较对照组低(P<0.05)。结论使用无创呼吸机可以有效改善慢性阻塞性肺疾病合并II型呼吸衰竭,减少呼吸肌耗氧,减轻呼吸肌疲劳,纠正缺O2和CO2潴留,明显缩短治疗时间,减少医疗费用,值得临床应用推广。

Objective To explore the effect of noninvasive mechanical ventilation on chronic obstructive pulmonary disease （COPD） patients with respiratory failure then provide the reference for clinical treatment. Methods The 40 AECOPD patients with type II respiratory failure admitted our department from the February of 2007 to the February of 2010. These patients were divided into theobservation group and the control group. All of them were treated with oxygen therapy, antibiotics, expectorant, bronchodilator, respiratory stimulant, glucocorticoids and supportive treatment. Meanwhile, the observation group was added BiPAP. After treatment, compare the heart rate, breathing rate and blood gas were analyzed between the two groups. Results After treatment pH was 7.39±0.04, PCO2 （54±14） mmHg, PO2 （47±6） mmHg, SO2 （97.6±2.3）%, RR （98±14） times/min, and HR （23±5） times/min in observe group, while pH （7.39±0.04）, PCO2 （54±14） mmHg, PO2 （47±6） mmHg, SO2 （97.6±2.3）%, RR （98±14） times/min, HR （23±5） times/rain, the effect in observe group was better than that in control group （P〈0.05）. The hospital stay in observe group was shorter than that in control group （P〈0.05）, and hospitalization costs was lower in observe group than that in control group （P〈0.05）. Conclusion The noninvasive mechanical ventilation can ameliorate the respiratory failure, respiratory muscle oxygen consumption and respiratory muscle fatigue, improve hypoxia and carbon dioxide retention, and reduce treatment time and treatment expense of COPD patients with type II respiratory failure.