无创正压通气在AECOPD合并Ⅱ型呼吸衰竭早期伴有意识障碍患者中的临床应用研究

Clinical application study of noninvasive positive pressure ventilation on early stage of AECOPD combined typeⅡ respiratory failure of patients with conscious disturbance

目的：研究无创正压通气在AECOPD合并Ⅱ型呼吸衰竭早期伴有意识障碍患者中的临床应用效果。方法对2011年3月～2014年6月我院收治的160例AECOPD合并Ⅱ型呼吸衰竭早期伴有意识障碍患者进行回顾性分析，采取有创机械通气治疗的80例患者为对照组，采取无创正压通气治疗的80例患者为观察组。观察比较两组患者治疗前后的呼吸频率（RR）、心率（HR）、动脉PaO2以及PaCO2指标的变化情况。结果治疗后，观察组80例患者的治疗总有效率为81.25％，明显高于对照组的63.75％，组间差异有统计学意义（P＜0.05）；两组患者的临床症状及指标均获得明显改善，研究组患者的呼吸频率、心率等显著下降，并趋于正常，动脉血气PaO2明显升高、PaCO2显著降低，与对照组相比差异有统计学意义（P＜0.05）。结论无创正压通气在AECOPD合并Ⅱ型呼吸衰竭早期伴有意识障碍患者的临床治疗中效果显著，能有效的改善患者的意识、临床症状、呼吸频率、心率、动脉血气等症状。值得广泛推广和应用。

Objective To study the effect of clinical application of noninvasive positive pressure ventilation（NIPPV） on early stage of AECOPD combined type Ⅱ respiratory fallure of patients with conscious disturbance. Methods 160 patients with conscious disturbance at early stage of AECOPD combined type Ⅱ respiratory fallure, who were treated in our hospital from March 2011 to June 2014, were retrospectively analyzed, and divided into control group of 80 patients who were treated with invasive mechanical ventilation（MV） and observation group of 80 patients who were treated with NIPPV. To observe and compare the changes of respiratory rate（RR）, heart rate（HR）, the indexes of artery PaO2 and PaCO2 of patients pre and post treatment between the two groups. Results The total effective rate of treatment after operation in observation group（81.25%） was obviously higher than which in control group（63.75%）, the differences was statically significant between the two groups（P〈0.05）. The clinical symptoms and the indexes of the two groups were all had obviously improvement, while RR and HR of observation group had significantly decreased and had tended to be normal, artery PaO2 had significantly increased, and PaCO2 had significantly decreased, the differences was statically significant between the two groups（P 〈 0.05）. Conclusion NIPPV on early stage of AECOPD combined type Ⅱ respiratory fallure of patients with conscious disturbance has significant clinical effect, could effectively improve the consciousness, the clinical symptoms, RR, HR, and arterial blood gas of patients, is worthy of clinical extensive application and popularization.