无创机械通气对伴有意识障碍的重症呼吸衰竭患者治疗价值的探讨

目的 探讨无创机械通气抢救伴有意识障碍的重症慢性阻塞性肺疾病(COPD)呼吸衰竭患者的临床疗效.方法 COPD伴意识障碍的重症呼吸衰竭患者42例,使用硅胶面膜口鼻面罩接瑞士Hamilto n公司生产的GALILEO或RAPHAEL急救用呼吸机,采用压力-同步间歇指令通气P-(SIMV)+压力支持通气(PSV)+呼气未正压通气(PEEP)模式进行无创机械通气,同时采取常规抗感染等综合治疗.观察治疗前后生命体征、神志、呼吸肌疲劳程度及血气指标的变化等指标.其中神志评估采用Glasgow昏迷评分(GCS),以辅助呼吸肌评分评价呼吸肌疲劳程度. 结果 42例均成功接受治疗,与人院时(O h)相比,治疗后2 h、6 h及24 h的pH值、二氧化碳分压(PaCO2)、氧和指数即动脉氧分压/吸氧浓度(PaO2/FiO2)均显著改善.24 h后呼吸频率及心率均明显下降,提示患者病情趋于稳定并对治疗较为耐受.平均GCS由(5.69±0.93)分,提高为(10.45±1.23)分(t=31.68,P<0.001),意识状态明显改善.全部患者辅助呼吸肌评分由(3.70±0.45)分降至(2.06±0.52)分(t=31.21,P<0.001),呼吸肌疲劳缓解. 结论 无创机械通气在抢救重症感染及伴有意识障碍的重症COPD呼吸衰竭患者中临床疗效显著.

The therapeutic value of noninvasive mechanical ventilation in patients with conscious disturbance due to severe chronic obstructive pulmonary disease complicated with respiratory failure

Objective To investigate the therapeutic value of noninvasive mechanical ventilation in patients with conscious disturbance due to severe chronic obstructive pulmonary disease (COPD) with respiratory failure. Methods Forty-two patients with conscious disturbance due to COPD complicated with respiratory failure were selected in the study. GALILEO or PAPHAEL large EMT ventilator produced by Switzerland Hamilton Company was used for noninvasive mechanical ventilation with P-SIMV+PSV+PEEP mode. Meanwhile, the change of vital signs, consciousness, the degree of inspiratory muscle fatigue and blood gas indexes were observed before and after treatment. Glasgow coma scale (GCS) was applied to evaluate the consciousness, and scale for accessory muscle use was adopted to measure the degree of inspiratory muscle fatigue. Results All the patients were treated successfully. Compared with admission, the pH value, the pressure of arterial carbon dioxide (PaCO2) and the arterial oxygen pressure/inhaled oxygen concentration (PaO2/FiO2)were significantly improved 2 hours, 4 hours and 24 hours after treatment. The respiration rate and heart rate were markedly decreased 24 hours after treatment, which indicated that the condition of the patients tended to be stable and the patients could endure the therapy. The average GCS was increased from 5.69-1-0.93 to 10.45±1.23 (t= 31.68, P<0.001), and the state of consciousness was improved significantly. The scale for accessory muscle use was decreased from 3.70±0. 45 to 2. 06±0. 52 (t = 31.21, P < 0. 001), and the respiratory muscle fatigue was relieved. Conclusions Noninvasive mechanical ventilation has obvious clinical curative effect on severe infection and conscious disturbance due to severe COPD complicated with respiratory failure.