无创双水平气道正压通气-同步间歇指令通气-压力支持通气治疗呼吸衰竭

THE EFFICACY OF NBIPAP-SIMV-PSV IN RESPIRATORY FAILURE PATIENTS

目的 观察无创双水平气道正压通气 -同步间歇指令通气 -压力支持通气 (NBIPAP -SIMV -PSV)组合模式对慢性阻塞性肺病 (COPD)合并呼吸衰竭的疗效。方法 选择 36例COPD合并呼吸衰竭患者 ,在常规治疗基础上加用NBIPAP -SIMV -PSV ,监测并比较通气治疗前、治疗后 2h、4h、HR、RR、Bp、PaO2 、PaCO2 和SaO2 变化。结果 通气治疗前后各参数变化比较 :通气治疗后HR、RR明显减慢 ;PaO2 与SaO2 显著提高 ;PaCO2 显著下降 ;Bp无明显变化。全部病例经 2～ 4d通气治疗后病情稳定 ,脱离呼吸机。结论 NBIPAP -SIMV -PSV可明显改善呼吸衰竭的症状和体征 ,迅速提高PaO2 与SaO2 值 ,有效降低PaCO2 值。能明显改善人机同步性能 ,更节省呼吸功 ,患者更舒适。并明显缩短住院时间 (P <0 .0 1) ,显著减少医疗费用 ,可作为治疗COPD合并早、中期呼吸衰竭的一种简便、迅速、安全。

Objective To evaluate the efficacy of NBIPAP-SIMV-PSV in patients with COPD complicated by respiratory failure.Methods\ 36 cases with COPD complicated by respiratory failure were selected and treated by NBIPAP-SIMV-PSV on the basis of traditional treatment.The values of HR,RR,Bp,PaO 2,PaCO 2 and SaO 2 were monitored before treatment,2h and 4h after ventilation treatment respectively.Results\ The variation of values mentioned above showed:HR and RR decreased considerably (P<0.0001);PaO 2 and SaO 2 increased significantly (PaO 2:2h:P=0.002,4h:P=0.001;SaO 2 :P=0.0001);PaCO 2 decreased significantly (2h:P=0.002,4h:P=0.0001);Bp had no change (P>0.05).After 2～4 days' ventilation treatment,the conditions of all cases were steady and away from respiratory.Conclusion\ NBIPAP-SIMV-PSV can relieve the symptoms and signs in patients with respiratory failure obviously,increase PaO 2 and SaO 2 rapidly,decrease PaCO 2 effectively,improve person-machine synchronous quality significantly save respiratory work.It can also shorten hospitalization time (P<0.01) and cut down and the medical expenses.So NBIPAP-SIMV-PSV can be taken as a convenient,rapid,safe and effective treatment for patients with COPD comp;licated by early or middle phase of respiratory failure.