无创面罩通气在慢性阻塞性肺疾病所致重度呼吸衰竭中的应用

APPLY OF NONINVASIVE VENTILATION VIA FACE MASK IN SEVERE RESPIRATORY FAILURE CAUSED BY CHRONIC OBSTRUCTIVE PULMONARY DISEASE

目的 探讨无创面罩通气对慢性阻塞性肺疾病 (COPD)引起的重度呼吸衰竭的疗效 ,并观察其并发症。方法 采用经面罩气道正压通气的方法 ,吸气压自 4cmH2 O逐渐上升至 10～ 2 0cmH2 O ,呼气末压为 4～ 6cmH2 O ,呼吸备用频率 16～2 0次 /min ,吸气时间百分比 3 0 %～ 40 %。结果 2 3例重度呼吸衰竭患者经治疗后 ,通气后血气指标 (pH值、PaO2 、PaCO2 )明显好转于通气前 (P <0 0 5 ) ,症状改善 ,有效率达 65 2 2 %,死亡率 17 3 9%;多数患者在通气 1～ 2d后 ,血气有较大好转。排痰障碍 ,胃胀气为主要并发症。结论 无创面罩通气在重度呼吸衰竭治疗中如使用得当 ,可取得显著疗效 ,且可减少并发症。

Objective: To estimate the efficacy of noninvasive ventilation via face mask in severe respiratory failure(SRF) caused by chronic obstructive pulmonary disease(COPD),and observe its complications. Methods: To apply noninvasive ventilation via face mask,IPAP gradually increased from 4 cmH_2O to 10～20 cmH_2O,EPAP was 4～6 cmH_2O or so. Expiratory prepared rate was 16～20 times each minute. The percentage of inspiration time was 30～40. Results: Blood gas (pH、PaO_2、 PaCO_2) of post-ventilation was significantly better than that of pre-ventilation after 23 cases of SRF patients were treated ( P <0.05). The clinical manifestation was improved and the effective rate was 65.22% while the mortality was 17.39%. Blood gas of majority of patients was greatly better than it had been one or two days after ventilation. The sputum drainage disorder and stomach flatulence were major complications. Conclusions: Noninvasive ventilation may be obviously effective in treating SRF if used properly and it may also decrease its complication.