无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的疗效观察

Clinical study of noninvasive positive pressure ventilation in treatment of chronic obstructive pulmonary disease with acute exacerbation of respiratory failure

目的:观察无创正压通气在治疗慢性阻塞性肺疾病急性加重期(AECOPD)呼吸衰竭中的疗效。方法:选取2014年4月至2015年1月就诊于我院治疗的AECOPD呼吸衰竭的患者80例作为观察对象,两组均给予抗感染、祛痰、解痉、纠正电解质紊乱等对症支持治疗;治疗组给予Bi PAP Symchrony呼吸机经口鼻面罩进行无创正压通气(NIPPV)治疗;对照组给予鼻导管低流量通气治疗。观察比较:(1)两组患者的临床疗效;(2)比较两组患者通气前、通气后2、24 h和通气治疗结束时的RR、血气参数的变化;(3)两组患者气管插管机械通气率、平均住院时间。结果:治疗组患者治疗后的总有效率显著高于对照组(P<0.05)。治疗结束时,治疗组患者的RR、血气参数较治疗前、通气后2 h、通气后24 h明显改善,且治疗组患者的RR、血气参数较对照组改善更加明显,治疗组患者气管插管机械通气率、平均住院时间明显低于对照组,差异均有统计学意义(P<0.05)。结论:NIPPV治疗慢性阻塞性肺疾病急性加重期呼吸衰竭能明显提高临床疗效,提高患者的氧饱和度和氧分压,缩短住院时间、降低机械通气率,值得推广应用。

Objective To investigate the effect of noninvasive positive pressure ventilation NIPPV in treatment of chronic obstructive pulmonary disease with acute exacerbation of respiratory failure. Methods From April 2014 to January 2015, 80 patients with chronic obstructive pulmonary disease and acute exacerbation of respiratory failure in our hospital were enrolled in this study. The patients received anti-infectious, antispasmodic, expectorant, correct electrolyte imbalance and symptomatic and supportive cure. BiPAP Symchrony ventilator was applied in the patients in the treatment group, and low flow nasal catheter ventilation therapy was given to patients in the control group. The following parameters were observed and compared： （1）The clinical efficacy of two groups of patients; （2） RR, PaO2, PaCO2, pH changes of patients before and at 2, 24 hours after ventilation therapy. （3） Intubation and mechanical ventilation, mortality, average length of stay and complications that occur during treatment. Results After treatment, the total effective rate of patients in the treatment group was significantly higher than that of patients in the control group （P 〈 0.05）. At the end of treatment, RR, PaO：, PaCO2, pH changes, aeration at 2 h, 24 h post ventilation of patients in the treatment group improved significantly （P 〈 0.05）. The intubation and mechanical ventilation rate, mean hospital stay of patients in the treatment group were significantly shorter than theose of patients in the control group （P 〈 0.05）. Conclusion To patients with chronic obstructive pulmonary disease and acute exacerbation of respiratory failure, NIPPV can improve clinical outcomes, improve the patient＇s oxygen partial pressure and oxygen saturation, shorter hospital stays, inhibit the rates of mechanical ventilation.