尘肺并发慢性Ⅱ型呼吸衰竭康复中无创呼吸机的应用

Clinical application study of non-invasive ventilation in the treatment of the pneumoconiosis patients with chronic type Ⅱ respiratory failure

目的观察早期干预、间断应用双水平气道正压通气无创呼吸机在尘肺并发慢性呼吸衰竭患者康复中的疗效。方法将符合GBZ70-2009《尘肺病诊断标准》、入院后血气分析提示慢性Ⅱ型呼吸衰竭的尘肺病患者62例随机分为康复治疗组32例，对照组30例。两组患者均常规给予口服止咳化痰平喘药物氨溴索，多索茶碱等药物治疗。康复治疗组在常规组基础上每天间断给予无创呼吸机应用。康复组及治疗组分别于治疗开始前及治疗3个月后进行动脉血气分析、肺功能检查及呼吸困难分级、心脏彩超（心脏射血分数）测定。结果康复治疗组及对照组治疗前肺功能、血气分析、呼吸困难分级、右心射血分数差异无统计学意义（P〉0．05）。治疗后3个月治疗组患者二氧化碳分压（PaCO2）较对照组明显下降，氧分压（PO2）、第1秒用力呼气量（FEV1.0）及FEV1.0％、右心射血分数较对照组明显提高，差异均有统计学意义（P〈0．05）。结论早期使用无创呼吸机可以改善心肺功能，减轻痛苦，提高生存质量。

Objective To observe the effect of early intervention and intermittent application of bi level positive airway pressure ventilation （BiPAP） in patients with pneumoconiosis combined with chronic respiratory failure. Methods Will meet the diagnostic criteria of pneumoconiosis in GBZ70-2009〈 〉, the blood gas analysis in patients with chronic type Ⅱ respiratory failure in 62 cases were randomly divided into rehabilitation treatment group 32 eases, control group of 30 cases. Patients in the observation group were treated by on-invasive ventilation, while the control group were treated by the conventional treatment. The data such as arterial blood gas, pulmonary function, the grade about dyspnea and echocardiography was collected from the both group before the beginning of the treatment and after the three months. Results the PaO2 level, FEV1.0, FEV1.0% ,the grade of dyspnea and the Right Ventricular Ejection Fractions were not significantly different between the experimental group and the control before the start of the treatment （P〉0.05）. After the three month treatment, the PaO2 level of the observation was significantly lower the control （P〈0.05）. The data about FEV1.0, FEV1.0% and the Right Ventricular Ejection Fractions were higher than the control group （P〈0.05）. Conclusion Non- invasive ventilation has exactly effect in the treatment of the pneumoconiosis patients with Chronic Respiratory Failure. It can improve the function of the heart and lung and ease the pain of patients.