无创正压通气改善慢性阻塞性肺疾病并呼吸衰竭的临床观察

Clinical Observations of NPPV Improving the gas Ventilation of Patients with COPD and Respiratory Failure

目的 :评价无创正压通气 (NPPV)治疗慢性阻塞性肺疾病 (COPD)的临床效果。方法 :5 1例COPD急性加重并Ⅱ型呼吸衰竭患者随机分为常规治疗组 (2 6例 )和NPPV组 (2 5例 ) ,观察两组患者治疗前后动脉血气变化及病情转归。结果 :与治疗前比较 ,NPPV组治疗 2 4h后PaO2 明显升高 ,PaCO2 明显下降 (P <0 .0 1) ,常规治疗组治疗 2 4h后PaO2 亦有上升 (P <0 .0 5 ) ,PaCO2 则无明显变化 ,(P >0 .0 5 )。治疗 2 4h后NPPV组PaO2 升高和PaCO2 下降较常规治疗组更为显著 (P <0 .0 5 )。常规治疗组的失败率 (34.6 % )显著高于NPPV组 (16 .0 % ,P <0 .0 5 )。NPPV组的平均住院天数 (14 .5± 6 .7)d明显短于常规治疗组 (2 3.8± 9.2 )d ,P <0 .0 5。结论 :NPPV可明显改善COPD急性加重并Ⅱ型呼吸衰竭患者的气体交换 ,纠正低氧血症和高碳酸血症 ,提高抢救成功率。

Objective: To evaluate the clinical effect of NPPV for respiratory failure in the patients with chronic obstructive pulmonary disease(COPD). Methods:Fifty one patients with COPD and type II respiratory failure were randomly divided into two groups: conventional therapy(CT) group and noninvasive positive pressure ventilation(NPPV) group. The arterial blood gases were observed before and after the treatment. Prognosis was analyzed in the two groups. Results:Compared with pre-treatment, the level of PaO 2 was apparently increased and the PaCO 2 decreased after 24 hour by NPPV (P<0.01). In CT group the level of PaO 2 was increased, PaO 2 was unchanged after treatment. The degree of increase or decrease has significant differences between the two groups (P<0.05). The failure rate of treatment in CT group(34.6%) was higher than the NPPV group(16.0%,P<0.05). The average hospitalization day of the NPPV group was significantly shorter than the CT group. Conclusion: NPPV can effectively improve the gas ventilation with correcting hypoxia and hypercapnia, and to increase the successful rescue rate in the patients with COPD and type II respiratory failure.