无创正压通气对慢性阻塞性肺疾病急性发作期并重度二氧化碳潴留患者疗效及安全性分析

Efficacy and safety analysis of non-invasive positive pressure ventilation treatment in patients with acute exacerbation of chronic obstructive pulmonary disease and high levels of carbon dioxide retention

目的研究无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性发作期(AECOPD)并重度二氧化碳潴留患者的效果及安全性。方法 41例经NPPV治疗的AECOPD并呼吸衰竭患者,根据动脉血二氧化碳分压(Pa CO2)潴留程度分为重度二氧化碳潴留组(A组)和轻中度二氧化碳潴留组(B组)。其中A组17例,Pa CO2≥80 mm Hg(1 mm Hg=0.133 k Pa),平均(90.2±9.8)mm Hg;B组24例,50 mm Hg≤Pa CO2<80 mm Hg,平均(68.2±6.3)mm Hg。对比分析两组患者NPPV治疗后2、24、48 h生命体征及动脉血气变化,并观察其并发症情况。结果两组患者NPPV治疗后2、24、48 h时p H值及动脉血氧分压(Pa O2)均较治疗前显著升高(P<0.05),Pa CO2显著下降(P<0.05);但两组患者疗效及并发症发生率组间比较差异未见统计学意义(P>0.05)。结论 NPPV对AECOPD并重度二氧化碳潴留患者有较好的救治效果及相对安全性。

Objective To study the efficacy and safety of non-invasive positive pressure ventilation（NPPV）treatment in pa-tients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）and high levels of carbon dioxide retention. Methods Forty-one patients with AECOPD combined with respiratory failure who were treated by NPPV were divided into two groups according to the degree of retention of the PaCO2 ,Group A：17 cases,PaCO2≥80 mmHg（1 mmHg = 0. 133 kPa）,with an average of（90. 2 ± 9. 8）mmHg;group B：24 cases,50 mmHg≤PaCO2 ﹤ 80 mmHg,with an average of（68. 2 ± 6. 3）mmHg. The changes of vital signs and arterial blood gas of the two groups after treatment of 2,24,48 hours were ana-lyzed,and the complication incidences were observed. Results Compared with before treatment,the pH value and PaO2 after treatment of 2,24,48 hours were significantly increased（P ﹤ 0. 05）,and PaCO2 was significant reduced（P ﹤ 0. 05）. The cura-tive effect and complication incidence between the two groups had no significant difference（P ﹥ 0. 05）. Conclusion NPPV in patients with AECOPD and high levels of carbon dioxide retention has good treatment effect and relative safety.