无创正压通气加平台呼气阀治疗AECOPD并肺性脑病的疗效评价

The Effect of Noninvasive Positive Pressure Ventilation plus Plateau Exhalation Valve in the Treatment of AECOPD with Pulmonary Encephalopathy

目的探讨无创正压通气(NPPV)治疗危重症流感的临床疗效。方法 2009年11月—2012年5月该院呼吸重症监护(RICU)收治的108例危重症流感患者,常规治疗的同时予NPPV治疗,观察通气2h后、24h后及撤机后的呼吸频率及血气分析的变化。结果 NPPV治疗重症流感所致急性肺损伤/急性呼吸窘迫综合症(ALI/ARDS)2h后,患者PaO2明显改善,呼吸频率逐渐下降;24h以后呼吸窘迫症状渐趋缓解,大部分能维持至病情好转,成功撤机。108例患者中,除17例因病情恶化及1例无法耐受改为IPPV外,其余病例和治疗前比较,PaO2和RR得到明显改善。结论 NPPV治疗流感危重症患者方便,并发症少,对于血流动力学稳定和有自主呼吸的患者治疗有效,早期应用NPPV对于改善患者的病理生理状态,避免IPPV有积极的意义。

Objective To discuss the clinical effect of noninvasive positive pressure ventilation （NPPV） in the treatment of severe influenza. Methods 108 patients with severe influenza admitted in our hospital respiratory intensive care unit （RICU） from November, 2009 to May, 2012 were given conventional therapy and NPPV treatment. Changes of respiratory frequency and blood gas analysis were observed 2 h, 24 h after ventilation and removing the ventilator respectively. Results After 2-hour treatment of NPPV for ALI/ARDS, the patients＇ PaO2 improved obviously and their respiratory frequency decreased gradually. After 24-hour treatment, most patients＇ symptoms of respiratory distress gradually eased, and they maintained the treatment until the condition improved and successfully removed the ventilator. Except 18 patients changed to accept the treatment of IPPV,17 due to disease progression and 1 case of intolerance to NPPV, the rest patients＇ PaO2 and RR improved obviously compared with those before the treatment. Conclusion NPPV treatment is convenient and has less complications in the treatment of patients with severe influenza, especially those patients with stable hemodynamics and spontaneous breathing. To the patients with severe influenza, early application of NPPV can avoid IPPV therapy for it can improve their pathological and physiological state.