无创通气治疗慢性阻塞性肺疾病急性发作伴呼吸衰竭的临床研究

Evaluation of non-invasive ventilation in acute respiratory failure with chronic obstructive pulmonary disease

目的 探讨无创通气在慢性阻塞性肺疾病急性发作伴呼吸衰竭中的应用。方法 将 5 0例慢性阻塞性肺疾病急性发作伴Ⅱ型呼吸衰竭患者随机分为 2组 ,每组 2 5例 ,在进行抗感染、平喘、祛痰等常规治疗的同时 ,分别予持续静脉滴注可拉明及Bi PAP呼吸机无创通气治疗 4h。观察血气分析变化和临床结果。结果 经可拉明治疗 4h后 ,患者血 pH值和动脉血二氧化碳分压 (PaCO2 )较治疗前均无明显变化 (P >0 .0 5 ) ,而使用Bi PAP呼吸机治疗 4h后 ,PaCO2 明显下降 (P <0 .0 1) ,pH明显上升 (P <0 .0 1)。治疗前后两组动脉血氧分压(PaO2 )均有明显增高 (P <0 .0 1) ,且Bi PAP呼吸机治疗 4h较经可拉明治疗 4h的PaO2 增高更明显 (P <0 .0 1)。结论 Bi PAP呼吸机适用于慢性阻塞性肺疾病急性发作伴呼吸衰竭患者 ,其改善二氧化碳储留和低氧血症的疗效明显优于呼吸兴奋剂 ,且使用方便 ,患者易接受 ,还可缩短治疗时间 。

Objective To observe the effect of non-invasive ventilation (NIV) in acute respiratory failure with chronic obstructive pulmonary disease(COPD). Methods Fifty patients with acute hypercapnia respiratory failure (AHRF) and hypoxemia due to chronic obstructive pulmonary disease(COPD) exacerbation were prospectively and randomly assigned into two groups. Group 1 using by Nikethamide(n=25), and group 2 using by Bi-PAP(n=25), they sequentially used the Nikethamide or non-invasive ventilation(Bi-level positive airway pressure, Bi-PAP) for 4 hours during antibiotics, antispasmotic and antitussive treatment. The arterial blood gas contents were examined before treatment and after 4 hours of therapy. Results The pH and PaCO 2 using Nikethamide could not be improved(P>0.05),but the pH using Bi-PAP could be significantly increased(P<0.01) and the PaCO 2 was significantly reduced(P<0.01), and PaO 2 in both two groups could be significantly increased (P<0.01). Conclusion This study shows that NIV (Bi-PAP) may be more effective and acceptable than Nikethamide used in COPD with acute respiratory failure in the emergency department.