经面罩机械通气治疗慢性阻塞性肺疾病呼吸衰竭患者的回顾性分析

A retrospective study on the treatment of patients with chronic obstructive pulmonary disease by face mask mechanical ventilation

目的 评价经面罩机械通气 (FMMV)治疗慢性阻塞性肺疾病 (COPD)呼吸衰竭患者的疗效及影响因素 ;比较FMMV与人工气道机械通气 (ETMV)的效果和效率。方法 (1 )根据呼吸机和面罩的性能、连接方式、通气方法分为初期、中期、完善期和推广期 ,比较FMMV的效果和副作用。 (2 )选择进行FMMV ,以符合建立人工气道条件的患者与ETMV比较。结果 FMMV患者占总机械通气(MV)患者的比例、FMMV的有效率、住院患者的总有效率逐期上升 ,4期分别为 4 8% (1 1 / 2 3)、79% (1 5 /1 9)、85 % (2 9/ 34)、91 % (2 2 3/ 2 4 6 ) ;4 6 % (5 / 1 1 )、6 7% (1 0 / 1 5 )、83% (2 4 / 2 9)、89% (1 98/ 2 2 3) ;71 % (35 /4 9)、71 % (2 0 / 2 8)、81 % (34/ 4 2 )、88% (2 34/ 2 6 6 )。鼻梁部糜烂和胃胀气的比例逐期下降 ,4期分别为2 7% (3/ 1 1 )、1 3% (2 / 1 5 )、7% (2 / 2 9)、2 % (4 / 2 2 3)、4 6 % (5 / 1 1 )、4 0 % (6 / 1 5 )、2 1 % (6 / 2 9)、5 % (1 1 / 2 2 3)。与ETMV比较 ,FMMV患者的机械通气时间、住院时间缩短 ,呼吸机相关性肺炎的发生率下降 ,住院患者的有效率升高。结论 技术因素、呼吸机和面罩性能是影响FMMV效果的主要因素 ,FMMV可用于大部分COPD呼吸衰竭患者 ,且较ETMV有更好的效果和更高的效率 。

Objective To assess the effect and the influencing factors in face mask mechanical ventilation (FMMV) for the treatment of COPD with respiratory failure (RF), and to compare the efficacy and efficiency of FMMV with endotracheal intubation mechanical ventilation (ETMV) Methods From 1991 to 2001, 4 ventilating periods were named initial, middle, late, and extending stage according to ventilators, face masks and mechanical ventilating methods The results of FMMV in the 4 periods were compared The results in patients with FMMV who reached the endotracheal intubation criteria were also compared with those in ETMV ones from 1988 to 1990 Results 385 patients with COPD and RF were admitted to RICU The proportion of FMMV in all MV patients increased [48%(11/23), 79% (15/19), 85%(29/34), 91%(223/246)]; at the same time the effective rate of FMMV [46%(5/11), 67%(10/15), 83%(24/29), 89%(198/223)] and the total effective rate [71%(35/49), 71% (20/28), 81%(34/42), 88%(234/266)] also increased 83 percent of the patients who suffered from severe disturbances of consciousness in the late and extending stage were successfully weaned from FMMV Complications including the rates of nasal bridge erosion [27%(3/11), 13%(2/15), 7%(2/29), 2%(4/223)] and the rates of stomach distension [46%(5/11), 40%(6/15), 21%(6/29), 5%(11/223)] all decreased The ventilation times and length of stay were significantly shorter than those in patients with ETMV The rate of nosocomial pneumonia and the mortality of inpatients were significantly lower Conclusion The ventilating techniques, ventilators and face masks were the main factors influencing FMMV results FMMV could be used rationally for most COPD patients with RF as a valuable alternative to ETMV