无创正压通气在有反复气管插管史的肺心病急性加重期中的应用研究

The use of non-invasive positive pressure ventilation in the treatment of acutely exacerbated pulmonary heart disease after multiple endotracheal intubation-mechanical ventilation

目的 探讨无创正压通气 (NPPV)治疗有反复气管插管及机械通气史的慢性肺心病患者急性加重期的临床疗效和安全性。方法 对 33例曾接受过 2～ 5次气管插管的慢性肺心病急性加重期患者以双水平正压通气 (BiPAP)方式进行NPPV治疗。结果 33例中 2 0例(6 0 6 % )好转 ,其临床症状及血气分析指标明显改善 ,其中 1 5例在肺心病急性加重 2天内实施NPPV。 1 3例 (39 4 % )因病情恶化需要气管插管而进行有创机械通气治疗。NPPV治疗期间的并发症包括明显胃胀气 (8例 )及低氧血症和高碳酸血症加重 (5例)。结论 对于多数自主呼吸相对稳定的有反复气管插管及机械通气史的慢性肺心病急性加重期患者 ,NPPV治疗有效 ,且并发症少 。

Objective To assess the efficacy and safety of non invasive positive pressure ventilation (NPPV) in the treatment of cor pulmonale with acute exacerbation after multiple endotracheal intubation mechanical ventilation. Methods Thirty three patients with acute exacerbation of cor pulmonale, male 31, female 2, aged 81 4±4 7 years old, having undergone endotracheal intubation varying from 2 to 5 times, were treated with NPPV by Bi level positive airway pressure (BiPAP) mode. Results Among all patients, twenty of them (60 6%) could tolerate NPPV with significant improvement in pH(7 23±0 05 vs 7 39±0 04),PaCO 2 (9 98±2 27kPa vs 7 56±1 67kPa), PaO 2 (6 69±2 01kPa vs 10 92±2 33kPa), respectively ( P <0 01). Thirteen patients (39 4%) received endotracheal intubation mechanical ventilation because of aggravation of the disease condition. The complications of NPPV included gastric distension, aggravation of hypoxmia and hypercapnemia due to asynchronization with the ventilator. Conclusions NPPV was efficacious with a low incidence of complications in cor pulmonale patients, whose spontaneous respiration was relatively stable, though there was history of multiple endotracheal intubation mechanical ventilation. However, mechanical ventilation equipment should be prepared