无创通气治疗慢性阻塞性肺疾病并重度呼吸衰竭疗效观察

Clinical study of non-invasive ventilation in treatment of chronic obstructive pulmonary disease with severe respiratory failure

目的探讨无创通气(NIPPV)治疗拒绝有创通气的慢性阻塞性肺疾病急性加重期(AECOPD)合并重度呼吸衰竭患者的疗效观察。方法选择2017年6月至2018年3月期间东莞市人民医院呼吸内科收治的78例AECOPD合并重度呼吸衰竭患者为研究对象,所有患者均拒绝气管插管机械通气,给予NIPPV治疗,记录治疗前及治疗后动脉血氧分压(PaO2)、pH、动脉血二氧化碳分压(PaCO2)、心率(HR)、呼吸频率(RR)、格拉斯哥昏迷评分(GCS)等指标;59例治疗成功纳入成功组,余19例患者治疗失败,转气管插管机械通气治疗者纳入失败组,比较两组患者的年龄、性别等临床指标。结果患者NIPPV治疗2 h后的p H值、PaO2及GCS分别为(7.30±0.12)、(63.6±5.8) mmHg、(13.8±1.6)分,较治疗前明显升高,PaCO2、HR、RR分别为(80.2±4.7) mmHg、(105.6±9.2)次/min、(22.8±2.8)次/min,较治疗前明显降低,差异均有统计学意义(P<0.05);失败组患者的年龄、白细胞计数(WBC)、血肌酐分别为(75.2±8.2)岁、(14.82±3.29)×109/L、(99.53±16.87)μmol/L,均明显高于成功组的(66.9±7.4)岁、(12.72±2.15)×109/L、(87.72±15.94)μmol/L,p H、GCS分别为(7.15±0.13)、(10.19±1.27)分,明显低于成功组的(7.26±0.14)、(12.62±1.85)分,差异均有统计学意义(P<0.05)。结论无创通气治疗拒绝有创通气的AECOPD并重度呼吸衰竭患者,可以有效改善患者气体交换,疗效确切;年龄大、病情重及合并肾功能损伤均是影响NIPPV疗效的重要因素。

Objective To investigate the efficacy of non-invasive ventilation in the treatment of chronic obstructive pulmonary disease (COPD) with severe respiratory failure. Methods From June 2017 to March 2018, 78 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and severe respiratory failure were studied. The patients refused tracheal intubation mechanical ventilation and were treated with non-invasive positive pressure ventilation (NIPPV). The arterial blood arterial partial pressure of oxygen (PaO2), pH, arterial partial pressure of carbon dioxide (PaCO2), heart rate (HR), respiratory rate (RR) and Glasgow coma score (GCS) were recorded before and after treatment. Among the 78 patients, 59 with successful treatment were included in the success group, and the remaining 19 who failed were then treated with mechanical ventilation through endotracheal intubation (failure group). The clinical indicators such as age and gender were compared between the two groups. Results The pH, PaO2 and GCS were (7.30± 0.12), (63.6±5.8) mmHg and (13.8±1.6) respectively 2 h after treatment, which were significantly higher than those before treatment (P<0.05), and PaCO2, HR, RR were (80.2±4.7) mmHg, (105.6±9.2) times/min, (22.8±2.8) times/min, which were significantly lower than those before treatment (P<0.05). Age, white blood cell (WBC), and serum creatinine of the failure group were (75.2±8.2) years, (14.82±3.29)×109/L, (99.53±16.87) μmol/L, significantly higher than (66.9± 7.4) years, (12.72±2.15)×109/L, (87.72±15.94) μmol/L in the control group (P<0.05), and the pH and GCS were (7.15± 0.13), (10.19±1.27), significantly lower than (7.26±0.14), (12.62±1.85) in the success group (P<0.05). Conclusion The treatment of non-invasive ventilation in AECOPD and severe respiratory failure can effectively improve the gas exchange of the patients. Age, the severity of the disease, and the injury of the renal function are the important factors that affect the curative effect of NIPPV.