双水平无创正压机械通气治疗老年慢性阻塞性肺疾病合并呼吸衰竭的效果观察与护理

目的探讨双水平无创正压机械通气治疗老年慢性阻塞性肺疾病（COPD）合并呼吸衰竭患者的临床疗效及护理措施。方法 86例经临床确诊的老年COPD合并呼吸衰竭患者采用德国万曼BiPAP无创呼吸机行双水平无创正压机械通气治疗,并采取有效护理措施,包括心理护理、气道护理、呼吸机护理、营养支持。比较治疗前后患者氧分压（PaO2）、二氧化氮分压（PaCO2）、动脉血氧饱和度（SaO2）、pH值、呼吸、心率、血压变化;急性生理和慢性健康状况Ⅱ（APACHEⅡ）评分、格拉斯哥昏迷评分（GCS评分）、辅助呼吸肌评分变化;并观察患者行机械通气治疗过程中的不良反应情况。结果治疗后,患者平均PaO2、SaO2及pH值较治疗前显著提高（P〈0.05）,PaCO2显著降低（P〈0.01）;患者平均呼吸频率、心率、收缩压及舒张压均较治疗前显著改善（均P〈0.05）;平均APACHEⅡ评分及辅助呼吸肌评分均显著降低（P〈0.05）,GCS评分显著增加（P〈0.05）。86例患者无一例发生严重不良反应。结论双水平无创正压机械通气辅助有效护理措施治疗老年COPD合并呼吸衰竭患者临床效果好,创伤小,无明显严重不良反应,值得临床推广应用。

Effect and nursing intervention of elderly patients with COPD combined with respiratory failure treated by BiPAP

Objective To investigate the clinical effect and nursing intervention of elderly patients with COPD combined with respiratory failure treated by BiPAP.Methods A total of 86 elderly patients with COPD combined with respiratory failure underwent BiPAP using VENTI Motion BiPAP breathing machine,and also received effective nursing intervention,including mental nursing care,airway nursing care,breathing machine care and nutritional support.The changes of PaO2,PaCO2,SaO2,pH,breath rate,heart rate,blood pressure,APACHEⅡ score,GCS score and accessory respiratory muscle score before and after treatment were analyzed,and the adverse effect during the treatment of BiPAP was also observed.Results After treatment,mean PaO2,SaO2 and pH were statistically increased than those before treatment（P 0.05）,meanwhile PaCO2 was decreased（P 0.01）;mean breath rate,heart rate,systolic blood pressure and diastolic blood pressure were obviously improved than those before treatment（P 0.05）;mean APACHEⅡ score and accessory respiratory muscle score were significantly lower than those before treatment（all P 0.05）,and GCS score was significantly higher than that before treatment（P 0.05）.No one case of severe adverse effect was observed during the treatment.Conclusion BiPAP added with effective nursing intervention can receive good effect in the treatment of elderly patients with COPD combined with respiratory failure,the injure is mild and no severe adverse effect occurs,thus it is worthy of extensive application in clinic.