无创正压通气治疗AECOPD合并呼吸衰竭高碳酸血症意识障碍临床分析

Noninvasive Positive-pressure Ventilation for the Treatment of AECOPD Complicated with Hy- percapnic Consciousness Disorder Secondary to Respiratory Failure

【目的】探讨呼吸重症监护病房的慢性阻塞性肺病（COPD）急性加重期（AECOPD）合并高碳酸血症意识障碍疗效观察。【方法】回顾性分析对39例AECOPD合并呼吸衰竭高碳酸血症意识障碍患者8≤GCS评分〈15在急性发作期入住呼吸重症监护病房，予无创正压通气治疗，观察机械通气前与机械通气后2h、d。、d2、ds的PH值、动脉二氧化碳分压（PaCO2）、碳酸氢根离子（HCO3-）、氧合指数指标的变化情况。根据无创通气治疗前GCS评分分为两组，A组为（10≤GCS评分〈15），B组为（8分≤GCS评分〈10分），对两组指标进行比较。【结果】无创呼吸治疗39例AECOPD意识障碍患者，平均住院时间为（17±10）d，住ICU的时间为（9土5）d，APACHE-Ⅱ评分平均（15．4±2．2）分。上呼吸机2h后GCS评分较机械通气前升高且有显著差异（P〈0．01），动脉血气指标的PaCO2值明显低于机械通气前（P〈0．01），治疗后pH高于机械通气前（P〈0．05）。对NIPPV治疗前GCS评分A组（10≤GCS评分〈15）同B组（8≤GCS评分〈10）相比，在APACHE-Ⅱ评分（P〈0．05）、pH值（P〈0．01）、PaCO：有显著差异（P〈0．01）。【结论】NIPPV对于AE-COPD合并呼吸衰竭高碳酸血症意识障碍有效，临床上能减少AECOPD及高碳酸血症呼吸衰竭患者的插管率及住院病死率。

[Objective] To explore the efficacy of noninvasive positive-pressure ventilation（NPPV） for the treatment of acute episode（AECOPD） complicated with hypercapnic consciousness disorder secondary to respiratory failure in respiratory intensive care unit. KMethods] Clinical data of 39 AECOPD patients with hypercapnic consciousness disorder secondary to respiratory failure[8≤GCS（Glasgow coma scale）〈15] admitted to respiratory intensive care unit were analyzed retrospectively. All patients were given NPPV. The changes of PH value, PaCO2, HCO3 and oxygenation index before and 2 h, d1, d2 and d3 after mechanical ventilation were observed. According to GCS score before NPPV, all patients were divided into group A（10≤GCS〈15） and group B（8≤GCS〈10）. The indexes were compared between two groups. [Results]All 39 patients were treated with NPPV. The average hospital stay was （17 ±10） days. The duration of ICU stay was （9 ± 5） days. Acute physiologic and chronic health evaluation（APACHE） Ⅱ score was （15.4±2.2） scores. Compared with mechanical ventilation, GCS 2h after mechanical ventilation increased, and there was significant difference（ P 〈0.01）. CO2 value in arterial blood gas indexes 2h after mechanical ventilation was obviously lower than that before mechanical ventilation（ P 〈0.01）. PH value after treatment was higher than that before mechanical ventilation（ P 〈0.05）. There was significant difference in APACHE Ⅱscore, PH value and PCO2 between group A and group B（ P 〈0.05, P 〈0.01, P〈0.01）. [Conclusion] NPPV for the treatment of AECOPD complicated with hypercapnie consciousness disorder secondary to respiratory failure is effective,and can reduce the intubation rate and hospitalization mortality of patients in clinical practice.