早期无创正压机械通气治疗慢性阻塞性肺病合并呼吸衰竭的随机对照试验

Non-invasive positive pressure ventilation for early treatment of respiratory failure due to exacerbation of chronic obstructive pulmonary disease: A random controlled trial

目的 探讨无创正压机械通气 (non invasivepositivepressureventilation ,NIPPV)用于治疗慢性阻塞性肺病(chronicobstructivepulmonarydisease ,COPD)急性加重合并呼吸衰竭的作用。方法 选择 40例COPD急性加重合并呼吸衰竭的患者 ,随机分为NIPPV组 (NIPPV +常规综合治疗 )和对照组 (常规综合治疗 )。观察动脉血气结果、呼吸频率、心率、血压、呼吸困难分级、辅助呼吸肌动用评分、插管率、病死率、住院时间、住院费用。结果 NIPPV组与对照组治疗后 2、72h比较PaO2 的差异具有非常显著性意义 (P <0 0 1) ,PaCO2 差异无显著性意义 (P >0 0 5 )。NIPPV组通气 2h后心率、呼吸频率、呼吸困难分级、辅助呼吸肌动用评分即较对照组显著降低。NIPPV组较对照组理论住院时间显著缩短 (P <0 0 1)。理论住院费用无显著增加 (P >0 0 5 )。结论 NIPPV与常规综合治疗比较可以迅速改善缺氧 ,缓解呼吸困难 ,改善呼吸肌疲劳 ,缩短理论住院时间 。

Objective To investigate the roles of non invasive positive pressure ventilation (NIPPV) in the management of respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods A total of 40 patients suffering from respiratory failure due to acute exacerbation of COPD were randomly divided into NIPPV group (NIPPV plus routine therapy) and control group (routine comprehensive therapy). Blood gases, respiratory rates, heart rates, blood pressure, dyspnea scores, scores of the activity of accessory respiratory muscles, intubation rate, fatality, duration of hospitalization, and cost of hospitalization were observed. Results There was significant difference in PaO 2 at 2 and 72 h after therapy between the NIPPV group and the control group( P <0.01), but no significant difference in PaCO 2 ( P >0.05). Respiratory rates, heart rates, dyspnea scores, and the scores of the activity of accessory respiratory muscles were significantly lower in the NIPPV group than those in the control group at 2 h after ventilation. The duration of hospitalization was significantly shorter in the NIPPV group than that in the control group ( P <0.05), but there was no difference in the cost of hospitalization between the two groups ( P >0.05). Conclusion NIPPV can improve hypoxia and dyspnea, relieve the respiratory muscle fatigue, and shorten the duration of hospitalization, but can not significantly improve the carbon dioxide retention in patients.