重度Ⅱ型呼吸衰竭不同机械通气疗法的临床观察

Clinical observasion of severe type Ⅱ respiratory failure treated with different mechanical ventilation therapy

目的:比较有创与无创通气治疗重度Ⅱ型呼吸衰竭的临床疗效。方法:选择于2009年7月至2012年7月在商丘市第一人民医院治疗的重度Ⅱ型呼吸衰竭患者64例,随机分为有创组与无创组,每组32例,无创组采用经鼻或鼻面罩通气治疗,有创组采用气管插管通气治疗,比较两组患者的血气指标及神志状态。结果:经过2 h的通气后,有创组患者氧分压显著提高,二氧化碳分压明显回落,意识逐渐恢复,持续通气时间为(7±2)d,顺利拔管31例,死亡1例;无创组氧分压显著提高,二氧化碳未明显回落,有7例病情加重,改行气管插管,有25例避免有创通气,免创率78.1%,死亡6例。结论:气管插管通气能迅速、显著的缓解重度Ⅱ型呼吸衰竭患者的动脉血气指标,无创通气以高死亡率来换取免创率是不可行的。

Objective： To compare the clinical efficacy of invasive and non-invasive ventilation in patients with severe respiratory failure of type Ⅱ.Methods： 64-severe type Ⅱ respiratory failure who were diagnosed in the hospital from July 2009 to July 2012.They were divided into two groups in random,the invasive group were treated with endotracheal intubation invasive ventilation,and non-invasive treated with non-invasive ventilation connect with nasal or nasal mask,the patient＇s blood gas analysis and the state of consciousness were compared.Results： After two hours ventilation,the oxygen partial pressure of invasive group were significantly increased,and the partial pressure of carbon dioxide of invasive group were dropped significantly,and the consciousness gradually recovered,continuous ventilation（7±2） d,31 were extubated,1 dead;In noninvasive group,7 aggravated his condition,treated with endotracheal intubation invasive ventilation,25 avoided from endotracheal intubation with the oxygen partial pressure increased significantly.78.1% patients avoided from endotracheal intubation,6 death.Conclusion： Treated with invasive ventilation,the index of arterial blood gas indicators can be quickly and significantly relieve in severe type Ⅱ respiratory failure.It is not feasible to create a high mortality rate in exchange for free non-invasive ventilation.