无创正压通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的疗效分析

Efficiency of non-invasive positive pressure ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with type H respiratory failure

目的 研究无创正压通气（NIPPV）治疗慢性阻塞性肺疾病急性加重（AECOPD）合并Ⅱ型呼吸衰竭的疗效。方法 选取2012年1月至2014年12月昆山市第一人民医院急诊医学科收治的AECOPD合并Ⅱ型呼吸衰竭患者47例。根据随机、对照的原则分为观察组（n＝24）和NIPPV组（n＝23），其中观察组给予常规抗感染、祛痰、平喘、持续低流量吸氧等治疗；NIPPV组在常规治疗的基础上加用NIPPV治疗。对比治疗24h、72h后患者的血气分析、心率及呼吸次数等指标。结果 与治疗前相比，两组患者在治疗后的第24小时和72小时，呼吸次数、心率、动脉血二氧化碳分压（PaCO2）和乳酸（Lac）显著降低（P＜0.05），动脉血氧分压（PaO2）和pH显著上升（P＜0.05）；而且与第24小时相比，第72小时的各值改善更为明显（P＜0.05）。两组患者在治疗后第72小时的N末端前脑钠肽（NT-proBNP）值也有显著下降（P＜0.05）。与观察组相比，NIPPV组患者的呼吸次数、心率、PaCO2、Lac、pH、PaO2和NT-proBNP均有更为显著的改善（P＜0.05）。此外，NIPPV组较观察组住院天数与住院费用明显减少（P＜0.05）。结论 NIPPV在治疗AECOPD合并Ⅱ型呼吸衰竭患者中疗效显著，值得临床推广应用。

Objective To determine the curative effect of non-invasive positive pressure ventilation （NIPPV） in the treatment of the patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated with type Ⅱ respiratory failure. Methods Forty-seven AECOPD patients complicated with type Ⅱ respiratory failure who admitted in our department from January 2012 to December 2014 were recruited in this study. They were randomly divided into the observation group （n=24） and the NIPPV group （n=23）. All patients were given conventional treatment, including antibiotics, expectorant, anti-asthma and persistent low flow oxygen therapies. The NIPPV group was additionally treated with NIPPV. The blood gas analysis results, heart rate, breathing rate and serum level of N-terminal pro-brain natriuretic peptide （NT-proBNP） were compared between the 2 groups before and at 24 and 72 hours after the treatment. Results Compared with the values before treatment, the heart rate, breathing rate, arterial partial pressure of carbon dioxide （PaCO2）, and serum level of lactic acid （Lac） were decreased significantly （P〈0.05）, while, PaO2 and pH value were elevated significantly at 24 and 72 hours after treatment in both groups （P〈0.05）, with those of the latter time point more significantly （P〈0.05）. The serum level of NT-proBNP was also reduced in the 2 groups at 72 hours after treatment （P〈0.05）. Compared with the observation group, the NIPPV group had more marked improvements in the heart rate, breathing rate, pH value, PaO2 ad serum levels of Lac and NT-proBNP （P〈0.05）. What’s more, this group also had significantly shorter hospital stay and reduced costs than the other one （P〈0.05）. Conclusion NIPPV has remarkable curative effect in the treatment of AECOPD patients complicated with type Ⅱ respiratory failure, and it is worthy of being widely applied in clinical practice.