头罩式无创正压通气对慢性阻塞性肺疾病患者的临床疗效

Clinical Effect of Noninvasive Positive Pressure Ventilation for Chronic Obstructive Pulmonary Disease

目的:探索头罩式无创正压通气(NIPPV)对慢性阻塞性肺疾病(COPD)患者的临床疗效。方法:选取2017年2月至2018年8月我院重症医学科62例COPD患者作为研究对象,采用随机数字表法随机分为NIPPV头罩组(n=32)和NIPPV鼻面罩组(n=30)。比较两组患者治疗前、治疗后2 h的二氧化碳分压(PaCO_2)、氧合指数(PaO_2/FiO_2)、呼吸频率(RR)、心率(HR)、pH以及动脉收缩压(SAP)的变化情况;同时比较两组患者的漏气发生率、NIPPV治疗时间、初始24 h治疗中断例数、住院死亡例数发生情况。结果:应用头罩式NIPPV治疗后,COPD患者PaCO_2水平降低,PaO_2/FiO_2指数提高,通气治疗2 h后,其HR、RR、SAP更容易下降至正常范围内,患者的病情得以缓解;两组患者住院病死率差异无统计学意义;而NIPPV头罩组患者治疗时间、初始24 h治疗中断率、漏气发生率均降低,差异均有统计学意义。结论:头罩式NIPPV治疗COPD患者具有较好的疗效和耐受性。

Objective:To explore the clinical efficacy of noninvasive positive pressure ventilation(NIPPV)with headgear on chronic obstructive pulmonary disease(COPD). Methods:From February 2017 to August 2018, 62 patients with COPD who were admitted to the department of critical care medicine in our hospital were selected as subjects, and they were randomly divided into the NIPPV hood group(n=32) and NIPPV nasal mask group(n=30).The changes of carbon dioxide partial pressure(PaCO2), oxygenation index(PaO2/FiO2),respiratory rate(RR),heart rate(HR), pH and systolic arterial pressure(SAP)were compared between the two groups before treatment and 2 h after treatment.At the same time,the incidence of air leak,the time of NIPPV treatment, the number of initial 24 h treatment interruptions, and the number of hospital deaths were compared between the two groups. Results:After the treatment of applying hood NIPPV, the PaCO2 levels in patients with COPD was effectively reduced, and PaO2/FiO2 was improved. After 2 h of treatment with NIPPV, HR, RR, and SAP were more likely to fall to the normal range, and the patient′s condition was relieved. There was no difference in hospitalized mortality rate of patients in the two groups. NIPPV apply time, initial 24 h treatment interruption, the number of air leaks were lower than those of nasal mask ventilation, the differences were statistically significant. Conclusion:Hood NIPPV has good curative effect and tolerability in the treatment of COPD patients. It is worthy of clinical promotion.