无创正压通气在慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭治疗中的价值:一个为期4年的回顾性分析

目的 评价无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭(呼衰)的价值.方法 选择2002年6月15日-2006年6月15日本院住院的COPD合并Ⅱ型呼衰患者351例,将进行面罩NIPPV者作为治疗组,未进行NIPPV治疗者作为对照组,再按血气分析的结果将患者分为4个亚组.轻度呼衰:50 mm Hg(1 mm Hg=0.133 kPa)≤动脉血二氧化碳分压(PaCO2)≤65 mm Hg;中度呼衰:66 mm Hg≤PaCO2≤80 mm Hg;重度呼衰:81 mm Hg≤PaCO2≤95 mm Hg;极重度呼衰:≥96 mm Hg.观察各组治疗前及治疗3 d后血气分析结果、住院时间、住院费用、插管率、病死率.结果 COPD伴不同程度Ⅱ型呼衰患者经NIPPV治疗后,其动脉血氧分压(PaO2)均有不同程度升高,PaCO2则均有不同程度降低,且重度和极重度呼衰患者治疗组与对照组pH值、PaO2、PaCO2比较差异均有统计学意义(P均<0.05).不同程度呼衰患者治疗组的住院时间、住院费用较对照组明显减少,插管率、病死率均较对照组明显降低;随呼衰程度加重,插管率、病死率均明显增加(P均<0.05).结论 NIPPV对不同程度COPD合并Ⅱ型呼衰患者有益.

Clinical value of noninvasive positive-pressure ventilation in chronic obstruction pulmonary disease combined with typeⅡ respiratory failure: a 4-year retrospective study

OBJECTIVE: To evaluate the value of noninvasive positive-pressure ventilation (NIPPV) in treatment of patients with chronic obstruction pulmonary disease (COPD) combined with type II respiratory failure (RF). METHODS: From June 15th, 2002 to June 15th, 2006, there were 351 inpatients with COPD combined with type II RF. Those treated with NIPPV were categorized as treatment group; those who were not treated by NIPPV served as control group. All patients were divided into four subgroups according to results of blood gas analysis as follows. Mild RF group: 50 mm Hg < or = arterial partial pressure of carbon dioxide (PaCO2) < or = 65 mm Hg, 1 mm Hg=0.133 kPa; medium RF group: 66 mm Hg < or = PaCO2 < or = 80 mmHg; severe RF group: 81 mm Hg < or = PaCO2 < or = 95 mm Hg; extremely severe RF group: > or = 96 mm Hg. NIPPV was used in treatment group on top of conventional treatment. Values of blood gas analysis, length of stay, cost of hospitalization, rate of cannulation and fatality rate were observed in all groups before treatment and after treatment. RESULTS: After being treated with NIPPV, all patients with COPD combined with type II RF in different degrees, arterial partial pressure of oxygen (PaO2) were raised in different degrees, and PaCO2 were all lowered in different degrees. Blood pH, PaO2 and PaCO2 showed statistically significant difference between treatment group and control group in severe and extremely severe RF patients (all P < 0.05). The length of stay of patients with RF in different degrees, was shortened obviously, also the cost of hospitalization, rate of cannulation and fatality rate were all significantly reduced in treatment group. In contrast to mild, medium RF patients, rate of cannulation and fatality rate were increased in extremely severe RF group (all P < 0.05). CONCLUSION: NIPPV is beneficial to COPD combined with type II RF in different degrees.