无创正压通气治疗AECOPD并呼吸衰竭160例疗效观察

Observation of curative effect of non-invasive positive pressure ventilation in the treatment of AECOPD patients complicated with acute respiratory failure

目的：总结无创正压机械通气（ NIPPV）在AECOPD合并呼吸衰竭治疗中的经验。方法160例AECOPD合并呼吸衰竭的患者,采用经口鼻面罩双水平正压通气,吸气峰压为13～25 cmH2O；呼气末压4～6 cmH2 O。 NIPPV无效者改为有创通气。观察指标包括：临床症状和动脉血气改善情况,根据动脉血气和临床症状的改善情况进行疗效评价。结果①NIPPV总有效率为85%。有效率与病情严重程度、年龄相关：NIPPV有效者,上机前动脉血气状况明显好于无效病例（ P 〈0．05）,有效者年龄平均值小于无效者（ P 〈0．05）。②24例NIPPV无效者中,22例改为有创通气,成功率为81．8%。结论①NIPPV对AECOPD合并呼吸衰竭患者的治疗有重要意义,可减少患者气管插管的痛苦和并发症,减少住院费用。②早期上机有利于提高治疗成功率。

Objective To sum up the experience of non-invasive positive pressure ventilation （ NIPPV） in＆amp;nbsp;the treatment of AECOPD patients complicated with acute respiratory failure. Methods 160 AECOPD patients com-plicated with acute respiratory failure received NIPPV via full face-mask were enrolled in the study. 13--25 cmH2 O of inspiratory peak airway pressure （ IPAP） and 4～6 cmH2 O of expiratory peak airway pressure （ EPAP） were deliv-ered. Invasive positive pressure ventilation was delivered when NIPPV failed. Their clinical status, changes of artery blood gases and ventilator application were observed. Results ①The total effective rate of NIPPV was 85%, which was related with the state of illness and age. NIPPV benefited patients were shown to produce significant improve-ments in arterial blood gases （P〈0. 05）, and they were younger than those ineffective patients （P〈0. 05）. ②22 patients, who failed NIPPV, received invasive positive pressure ventilation, and the effective rate was 81. 8%. Con-clusion ① NIPPV is important in the treatment of AECOPD patients complicated with acute respiratory failure, which can decrease the pain of invasive positive pressure ventilation and medical treatment cost. ② The early use of NIPPV can improve the effective rate.