不同无创正压通气模式治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭疗效比较

Comparison of clinical effect of different modes by NIPPV in the treatment of patients with AECOPD and ;respiratory failure

目的：探讨不同无创正压通气模式（NIPPV）治疗慢性阻塞性肺疾病急性加重期（acute estage of the chronic obstructive pulmonary disease,AECOPD）合并呼吸衰竭的临床疗效。方法收取2012年3月至2015年3月榆林市星元医院收治的 AECOPD合并呼吸衰竭患者80例作为研究对象,根据随机数字表法将其分为观察组与对照组各40例,观察组患者采用成比例辅助通气（proportional assist ventilation,PAV）模式,对照组采用双水平正压通气（bi-level positive airway pressure,BiPAP）模式进行治疗。对2组患者生命体征及动脉血气、呼吸力学各指标变化情况、临床疗效、并发症发生情况以及呼吸舒适度进行观察比较。结果治疗后所有患者 HR、RR、PaCO2均下降,pH、PaO2、SaO2均上升,差异较治疗前有统计学意义（P 〈0.05）。组间差异无统计学意义（P〉0.05）；观察组各通气参数与对照组相比差异无统计学意义（P 〉0.05）；治疗后2组患者总有效率及并发症发生率差异无统计学意义（P 〉0.05）；观察组呼吸舒适度明显高于对照组,差异有统计学意义（P〈0.05）。结论两种正压通气模式对于 AECOPD 均具有良好的治疗效果及安全性, PAV模式具有更佳的舒适度,值得临床推广应用。

Objective To explore clinical effect of different modes by NIPPV in the treatment of patients with acute estage of the chronic obstructive pulmonary disease （AECOPD） and respiratory failure.Methods Eighty patients with AECOPD and respiratory failure accepted in our hospital from Mar.2012 to Mar.2015 were randomly divided into observation group and control group with 40 cases in each.Patients in observation group underwent PAV mode,control group underwent BiPAP mode.Vital signs,arterial blood gas,respiratory mechanics,clinical effect,complication rate and respiratory comfort of two groups were observed and compared.Results HR,RR and PaCO2 were decreasing,pH,PaO2 and SaO2 were increasing of two groups,which had statistically significance compared to before treatment （P 〈0.05）.But the difference between two groups had no statistically significance （P 〉0.05）.Respiratory indexes of two groups had no difference （P 〉0.05）.Total efficacy and complication rate had no statistically difference（P〉0.05）.Respiratory comfort of observation group was obviously higher than control group with statistically significance （P 〈0.05）.Conclusions Two modes of NIPPV have good efficacy and safety in treatment of AECOPD with respiratory failure.PAV mode has a better respiratory comfort,which is worth clinical application.