无创通气治疗呼吸衰竭的临床疗效

目的探讨无创通气治疗呼吸衰竭的临床疗效。方法选取呼吸衰竭患者67例,在常规治疗的基础上均采用瑞思迈双水平无创正压呼吸机进行面罩辅助通气治疗,动态观察患者治疗前和治疗后2 h,12 h,24 h,48 h,动脉血气变化、临床转归、心率变化的情况。结果 67例呼吸衰竭患者中,6例在治疗过程中改为有创机械通气;61例患者经NIPPV治疗48 h后,对比如下:PCO2明显降低[治疗前(86.72±18.35)mm Hg vs治疗后(58.91±5.03)mm Hg](P<0.01);Pa O2明显升高[治疗前(54.52±11.32)mm Hg vs治疗后(94.12±18.30)mm Hg](P<0.01);p H值明显升高[治疗前(7.25±0.05)vs治疗后(7.39±0.07)](P<0.01);呼吸(R)明显减慢[治疗前(30.02±10.23)次/分vs治疗后(21.36±2.20)次/分](P<0.05);心率减慢[治疗前(108.86±10.52)次/分vs治疗后(100.08±9.38)次/分](P<0.05)。均脱机出院,有效率达91.05%(61/67)。呼吸衰竭患者67例有27患者合并不同程度意识障碍,经无创通气治疗后25例患者意识障碍很快恢复,仅2例患者意识症状无好转,4例患者因血液动力学恶化、呼吸困难无改善、病情加重改为有创通气治疗。结论双水平无创正压通气治疗呼吸衰竭疗效确切,但应掌握无创呼吸机的操作方法,只要符合机械通气指征就应尽早进行无创机械通气,意识障碍不是无创通气的绝对禁忌证。

Objective To study the clinical curative effect of noninvasive ventilation treatment of respiratory failure.Methods 67 patients with respiratory failure, on the basis of conventional treatment adopt rui si mai double the level of noninvasive positive pressure breathing machine auxiliary ventilation therapy with a mask, dynamic observation of patients before and after treatment for 2 h, 12 h, 24 h, 48 h, arterial blood gas, clinical outcome, and heart rate changes.Results Of 67 patients with respiratory failure, 6 cases in the treatment process to invasive mechanical ventilation, the NIPPV 48 hours after treatment, 61 patients significantly lower PCO2, （86.72±18.35） mmHg before treatment, （58.91±5.03） mmHg after treatment （P〈0.01）, PaO2 obviously increases, （54.52±11.32） mmHg before treatment, （94.12±18.30） mmHg after treatment （P〈0.01）, the pH value increased significantly, （7.25± 0.05） before treatment and after treatment of （7.39±0.07） （P〈0.01）, breathing slowed significantly, （30.02±10.23） before treatment times/min, （21.36±2.20） times/min after treatment （P〈0.01）, heart rate slows, （108.86±10.52） before treatment times/min, （95.08±9.38） times/min after treatment （P〈0.01）, all offline discharge, efficient was 91.05% （61/67）. 67 patients with respiratory failure with 27 patients with disorder of consciousness of varying degrees, after treatment with noninvasive ventilation of 25 patients with disturbance of consciousness recovery soon, no better, only 2 patients consciousness symptoms in 4 patients showed no improvement because of hemodynamic deterioration,difficulty in breathing, aggravation of invasive ventilation therapy instead.Conclusion Double the level of noninvasive positive pressure ventilation for respiratory failure curative effect, but should master the operation method of noninvasive ventilator, as long as the indications should be accord with mechanical ventilation for noninvasive mechanical ventilation as soon as possible, disturbance of consciousness is not the absolute contraindication of noninvasive ventilation.