无创正压通气联合口咽通气道治疗肥胖合并慢性阻塞性肺疾病高碳酸血症昏迷的临床观察

Non-invasive positive pressure ventilation combined with oropharyngeal airway for the treatment of hypercapnic coma in obese patients with acute exacerbation of chronic obstructive pulmonary disease

目的观察无创正压通气(NPPV)联合口咽通气道治疗肥胖合并慢性阻塞性肺疾病(COPD)急性加重期高碳酸血症昏迷患者的临床疗效。方法对入选的32例肥胖COPD急性加重期并高碳酸血症昏迷的患者分为观察组与治疗组。观察组使用NPPV联合口咽通气道治疗,对照组使用NPPV治疗2 h后,给予放置口咽通气道,同时继续NPPV治疗。评价2组患者治疗前后临床疗效指标,包括呼吸频率、心率、格拉斯哥昏迷指数(GCS)、动脉血气指标、腹围以及NPPV支持压力等。结果治疗2 h后,观察组呼吸频率、心率、二氧化碳分压(PaCO_2)均较治疗前明显下降(P <0. 05),GCS评分、p H值均较前显著升高(P <0. 05)。对照组患者相关临床指标与基线水平相比较差异无统计学意义(P> 0. 05),腹围较前明显增加(P <0. 05)。2组患者相关临床指标变化程度比较差异有统计学意义(P <0. 05)。对照组患者在治疗第4小时,临床疗效指标好转,与相应基线水平比较差异有统计学意义(P <0. 05)。结论 NPPV联合口咽通气道是肥胖COPD急性加重期高碳酸血症昏迷患者可供选择的一种治疗方法。

Objective To observe the clinical efficacy of non-invasive positive pressure ventilation(NPPV)combined with oropharyngeal airways in the treatment of obese patients with COPD exacerbations of hypercapnic coma.Methods Twenty-two obese patients with COPD exacerbation and hypercapnic coma were randomly divided into the observation group and treatment group.The observation group was treated with NPPV and oropharyngeal airway.After two hours of treatment with NPPV in the control group,the oropharyngeal airway was administered while NPPV was continued.Evaluation of the clinical efficacy before and after treatment,including respiratory rate,heart rate,Glasgow coma scale(GCS),arterial blood gas,abdominal circumference and NPPV pressure levels.Results After two hours of treatment,the respiratory rate,heart rate,PaCO2 in the observation group were significantly lower than the baseline(P<0.05),and the GCS score and PH value were improved(P<0.05).Compared to the baseline,there was no significant difference in clinical indicators in the control group(P>0.05),and the abdominal circumference increased significantly(P<0.05).There were statistically significant differences in the degree of changes in clinical indicators between the two groups(P<0.05).In the4 th hour of treatment,clinical parameters of the control group improved significantly compared to the baseline(P<0.05).Conclusion NPPV combined with oropharyngeal airway is an effective treatment for obese patients with COPD exacerbations of hypercapnic coma.