慢阻肺合并Ⅱ型呼吸衰竭患者早期使用无创呼吸机的效果及安全性

Efficacy and Safety of Early Use of Noninvasive in Copd Combined Type Ⅱ Patients with Respiratory Failure

目的:探讨对慢性阻塞性肺疾病(COPD)合并有Ⅱ型呼吸衰竭患者早期采用无创呼吸机进行呼吸支持的临床疗效及安全性。方法:对2014年6月-2015年6月笔者所在医院收治的90例COPD合并Ⅱ型呼吸衰竭患者进行观察,采用随机数字表法分为对照组(45例)和观察组(45例)。对照组采用吸氧、糖皮质激素、祛痰剂、止咳平喘药、抗生素等药物进行常规治疗,观察组在常规治疗基础上采用无创呼吸机进行呼吸支持。治疗7 d后,观察两组患者的死亡率、肺功能、动脉血气分析、呼吸改善情况,记录观察组漏气情况。随访1年,观察两组患者的复发情况。结果:观察组的肺功能水平、Pa O2水平明显高于对照组;观察组Pa CO2水平、死亡率、1年内复发率明显低于对照组,差异有统计学意义(P<0.05)。治疗期间,观察组出现漏气6次,经及时处理后顺利完成治疗。结论:无创呼吸机对机体的无创伤,患者的耐受性好,可以缓解呼吸肌疲劳,改善通气,可以降低患者死亡率。

Objective：To investigate the clinical efficacy and safety of noninvasive ventilator for respiratory support in patients with chronic obstructive pulmonary disease（COPD） complicated with type Ⅱ respiratory failure.Method：From June 2014 to June 2015, 90 cases of COPD complicated with type Ⅱ respiratory failure were observed.The patients were divided into the control group（45 cases） and the observation group（45 cases） with the method of random digits table.Control group was given conventional treatment with oxygen,sugar cortical hormone,expectorant,antitussive and antiasthmatic drugs, antibiotics and other drugs,the observation group in the conventional treatment on the basis of using noninvasive ventilator respiratory support.After 7 d treatment,the mortality rate,pulmonary function,arterial blood gas analysis,respiratory improvement of the two groups were observed,and the leakage of the observation group was recorded. One year follow-up,the recurrence of the two groups were observed.Result：The pulmonary function and Pa O2 level of the observation group were significantly higher than that of the control group.The level of Pa CO2,mortality and recurrence rate in the observation group were significantly lower than those in the control group,the difference was statistically significant（P〈0.05）.During the treatment,the observation group appeared 6 times,after treatment,the treatment was completed successfully.Conclusion：Noninvasive ventilator has no trauma to the body,the patient＇s tolerance is good,can alleviate respiratory muscle fatigue,improve ventilation,can reduce the mortality rate of patients.