BiPAP加PEV在老年慢性阻塞性肺疾病急性加重合并肺性脑病治疗中的应用

Application of noninvasive positive pressure ventilation plus plateau exhalation valve on pulmonary encephalopathy in patients with AECOPD in agedness

目的探讨无创双水平气道正压通气(BiPAP)呼吸机加平台呼气阀(PEV)对老年慢性阻塞性肺疾病急性加重(AECOPD)合并肺性脑病患者的疗效。方法将50例AECOPD合并肺性脑病的患者随机分为治疗组(22例)和对照组(28例)。两组均予以抗感染、解痉平喘、止咳祛痰等常规治疗,根据痰培养及药敏结果应用敏感抗生素,并使用BiPAP呼吸机治疗。治疗组在此基础上加PEV。观察两组神志转清时间、生命体征(心率、呼吸频率)、动脉血气(PaCO2、PaO2、SaO2、pH值)、APACHEⅡ评分、格拉斯哥昏迷评分、辅助呼吸肌动用评分、预后及不良反应等。结果治疗组中2例行气管插管机械通气,死亡l例。对照组中5例行气管插管机械通气,死亡2例。治疗组与对照组相比,治疗后心率、呼吸频率、PaCO2及APACHEⅡ评分均明显下降,神志转清时间缩短,PaO2、SaO2、pH值及格拉斯哥昏迷评分明显上升,差异均具有统计学意义(P<0.01)。结论使用BiPAP呼吸机加PEV治疗AECOPD合并肺性脑病患者,有良好的同步性能和漏气补偿功能,提高了舒适感,增加了患者的依从性;能明显改善症状,缩短神志转清时间,迅速纠正低氧血症和CO2储留,疗效显著。

Objective To explore the efficacy of bi level positive airway pressure（BiPAP） ventilation plus plateau exhalation valve （PEV） in the treatment of pulmonary encephalopathy in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） in agedness. Methods Fifty AECOPD patients with pulmonary eneephalopathy were randomly divided into control group（22 cases） and treatment group （28 cases）. All patients received BiPAP ventilation and conventional therapy including antimierobial, bronchodilation, and ex pectorant treatment. In the treatment group, the BiPAP ventilator was connected to PEV additionally. Clinical symptoms, vital signs （ HR, RR） ,blood gas analysis （PaCO2, PaO2, SaOz, PH）, APACHE ]], Glasgow coma scale（GCS） , auxiliary for use score,and adverse reac tions were recorded. Results Heart rate, respiratory rate, PaCO2, and APACHE ]I score were significantly lower, and the time to recover consciousness was shorter ; meanwhile, PaO2 , SaO2, pH, and glasgow coma scale were significantly higher in the treatment group than those in the control group（ all P 〈 O. 01 ）. Two cases in treatment group and 5 cases in control group received tracheal intubation and invasive ventila tion due to treatment failure. Two elderly patients in control group died in hospital. Conclusion Noninvasive positive pressure ventilation plus PEV has good synchronization performance and a fiat compensation function, which increases the comfort and the patient compliance. This method can significantly improve symptoms, shorten the time to recover consciousness, and improve hypoxemia and hypercapuia rapidly in AE COPD patients in agedness with pulmonary encephaiopathy.