有创和无创正压通气治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭患者的效果比较

Effect comparison of invasive and non-invasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease combined with respiratory failure

目的比较有创和无创正压通气治疗慢性阻塞性肺疾病急性加重期（AECOPD）合并呼吸衰竭患者的效果。方法选择2012年1月～2015年10月池州市人民医院收治的AECOPD合并呼吸衰竭患者67例为研究对象。根据机械通气方法的不同分为有创通气组42例和无创通气组25例。观察两组患者机械通气治疗前及治疗后24h动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）、pH值、动脉血氧饱和度（SaO2）的变化；治疗前及治疗后24h采用酶联免疫吸附测定（ELISA）法测定脑钠肽（BNP）浓度；比较两组患者治疗结局。结果治疗前，两组患者的pH值、PaO2、PaCO2及SaO2比较，差异均无统计学意义（P〉0．05）；治疗后24h，两组血气分析指标均较治疗前明显改善，差异均有统计学意义（P〈0．05或P〈0．01）。治疗后24h，有创通气组SaO2高于无创通气组，但差异无统计学意义（P〉0．05）；有创通气组PaO2高于无创通气组，PaCO2低于无创通气组，差异均有统计学意义（P〈0．05）。有创通气组好转率高于无创通气组，死亡率稍低于无创通气组，但差异无统计学意义（P〉0．05）。治疗前两组患者BNP水平比较，差异无统计学意义（P〉0．05）；治疗后，两组患者BNP水平较治疗前明显降低，差异均有高度统计学意义（P〈0．01）：治疗后，有创通气组患者BNP水平低于无创通气组，差异有统计学意义（P〈0．05）。结论机械通气可有效改善AECOPD合并严重呼吸衰竭患者的通气功能，降低血浆BNP，且有创正压通气治疗效果优于无创正压通气，可提高治疗效果，降低病死率，值得临床推广应用。

Objective To compare the invasive and non-invasive positive pressure ventilation in patients with acute ex- acerbation of chronic obstructive pulmonary disease （AECOPD） combined with respiratory failure. Methods 67 patients with AECOPD combined with respiratory failure from January 2012 to October 2015 in the People＇s Hospital of Chizhou City were selected as the research objects, and they were divided into 42 cases of invasive ventilation group, 25 cases of non-invasive ventilation group according to different mechanical ventilation methods. The changes of arte- rial blood oxygen partial pressure （PaO2）, CO2 partial pressure （PaCO2）, pH value, arterial oxygen saturation （SaO2） of the two groups before and 24 h after mechanical ventilation treatment were observed; brain natriuretic peptide （BNP） concentration was determined by enzyme linked immunosorbent assay （ELISA） method before treatment and 24 h after treatment; outcome of the two groups was compared. Results Before treatment, pH, PaO2, PaCO2, SaO2 of patients in two groups had no statistically significant differences （P 〉 0.05）; 24 h after treatment, those analysis indicators of two groups were obviously improved, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. 24 h after treat- ment, SaO2 of the invasive ventilation group was higher than that of non-invasive ventilation group, but there was no statistically significant difference （P 〉 0.05）; PaO2 of the invasive ventilation group was higher than that of non- invasive ventilation group, and PaCO2 was lower than that of the non-invasive ventilation group, the differences were statistically significant （P 〈 0.05）. Improvement rate of the invasive ventilation group was higher than that of non-invasive ventila- tion group, and mortality rate was little lower than that of the non-invasive ventilation group, but there was no statisti-significant difference （P 〉 0.05）; after treatment, BNP of patients in two groups was significantly reduced, the differ- ences were highly significant （P 〈 0.01）; after treatment, BNP of patients in the invasive ventilation group was lower than that of the non-invasive ventilation group, the difference was statistically significant （P 〈 0.05）. Conclusion Me- chanical ventilation can effectively improve the ventilation function of patients with AECOPD combined with severe res- piratory failure and reduce plasma BNP. Therapy effect of invasive positive pressure ventilation is better than that of non-invasive positive pressure ventilation, which can improve the treatment effect and reduce the mortality, it is worthy of clinical popularization and application.