慢性阻塞性肺疾病呼吸衰竭患者有创机械通气后BiPAP序贯治疗

目的 :采用双水平气道正压通气 (BiPAP)呼吸机经口或鼻罩正压通气 ,探讨在重症呼吸衰竭有创机械通气后脱机过渡中的应用价值。方法 :慢性阻塞性肺疾病 (COPD)呼吸衰竭病人 3 2例 ,均行有创机械通气 ,脱机后病人分为常规治疗组 (治疗组 )和BiPAP呼吸机组 (对照组 )。上机 45min ,1 2h后测动脉血气 ,并计算重新插管率。结果 :BiPAP组治疗后 45min的pH ,PaCO2 ,PaO2 较治疗前有明显好转 (P <0 .0 5 ) ;1 2h的值pH ,PaCO2 ,PaO2 与 45min时相比差异无显著性 (P >0 .0 5 ) ;BiPAP组重新气管插管明显低于对照组 (P <0 .0 5 )。两组治疗前的基础情况差异无显著性 (P >0 .0 5 )。结论 :病人对BiPAP呼吸机耐受性好。BiPAP呼吸机能够改善COPD呼吸衰竭患者的通气功能 ,提高PaO2 ,降低PaCO2 ,并能使常规机械通气患者顺利脱机 ,减少重新插管率。

Sequential BiPAP following invasive mechanical ventilation in COPD patients with hypercapnic respirastory failure

Objective To estimate the feasibility and the efficacy of extubation and sequential bilevel positive airway pressure (BiPAP) in chronic obstrucive pulmonary disease(COPD) patients with exacerbated hypercapnic respiratory failure. Methods All patients were randomly divided into a control group and an experimental group. In addition to conventional therapy, the experimental group was treated with bilevel positive airway pressure via facial mask immediately, the control group was treated with conventional therapy alone. Results There were no difference in clinical characteristics and gas exchange at entry. pH value, PaCO 2 and PaCO 2 were significantly improved in experimental group following the first 45 minutes ventilation (P<0.05), but no additional improvement was observed when ventilation was extended to 12 hours (P>0.05). Reintubation rate was higher in the control group compared with the experimental group (P<0.05). Conclusion BiPAP can be well tolerated, and can improve ventilation funciton markedly. It can also facifiated the extubation, and reduced the reintubation rate in regular mechanical ventilation.