无创正压通气在COPD呼吸衰竭中的应用

A clinical study on the regimen of noninvasive positive pressure ventilation in treatment of respiratory failure due to COPD

目的 探讨无创正压通气在慢性阻塞性肺疾病 (下称 COPD)急性加重致轻、中度呼吸衰竭中的治疗方案。方法 96例患者入院时被随机分成三组 :A组仅常规治疗 ;B组加无创通气 2 h每日 2次 ,共 3日 ;C组加无创通气 4 h每日 2次 ,共 3日。结果 治疗 2 4 h和 4 8h后 ,3组患者每日 2次 ,共 3日 Pa O2 和 Pa CO2 的差别无显著意义 (p>0 .0 5 )。治疗 72 h后 ,与 A组相比 ,C组患者Pa O2 上升和 Pa CO2 下降均有统计意义 (分别为 p<0 .0 5 ,p<0 .0 1) ,而 A、B两组相比差异仍无显著性 (p>0 .0 5 )。C组患者平均住院天数比 A组短 (p<0 .0 5 ) ,A、B相比无统计意义 (p>0 .0 5 )。结论 无创正压通气 4 h,每日 2次 ,共 3日 ,治疗 COPD急性加重致轻、中度呼吸衰竭能提前改善患者的血气 ,缩短住院时间 ,而 2 h每日 2次 ,共

Objective To explore the regimen of noninvasive intermittent positive pressure ventilation (NIPPV) in treatment of mild to moderate respiratory failure due to acute exacerbation of COPD.Method A total of 96 patients with acute mild to moderate respiratory failure due to COPD were randomized into three groups: group A - conventional therapy only; group B - plus NIPPV 2h Bid 3d; group C - plus NIPPV 4h Bid 3d.Results The PaO 2 and PaCO 2 were similar among three groups after 24h and 48h treatment (p>0.05). After 72h therapy, compared with group A (conventional therapy), group C (NIPPV 4h Bid) showed greater reduction in PaCO 2 and improvement in PaO 2 ( p <0.01, p <0.05 respectively ), with no difference between group B and group A (p >0.05 ).The hospital length of stay in group C (12.4±4.3 d ) was shorter than in group A (15.0±5.3 d ,p <0.05 ), whereas no significant difference was shown between group B (14.0±6.1d ) and group A (p>0.05) . Conclusion The regimen of NIPPV 4h Bid 3d leads to more rapid improvement in blood gas and reduces the length of hospital stay and NIPPV 2h Bid 3d only costs more.