带储气囊无重复呼吸面罩在COPD患者脱机后的应用

目的探讨带储气囊无重复呼吸面罩、普通面罩及经鼻吸氧在慢性阻塞性肺病(COPD)脱机后的优缺点。方法选取2010年6月至2013年1月郧县人民医院收治的须行气管插管机械通气的COPD急性发作并发重度呼吸衰竭患者66例,依据随机数字表法分为三组:第1组(22例)脱机后应用带储气囊无重复呼吸面罩吸氧,第2组(22例)应用普通面罩进行吸氧,第3组(22例)应用鼻导管进行吸氧。比较三组3 d内再次应用呼吸机人次、脱机后24、48、72 h血气分析中pH、二氧化碳分压、氧合指数。结果再次应用呼吸机患者会在第1、2、3组分别为2、6、8人次,再次上呼吸机率分别为9%、27%、36%。脱机后24、48、72 h,三组患者的二氧化碳分压、氧分压、pH比较差异均有统计学意义(P<0.05)。结论带储气囊无重复呼吸面罩应用于COPD可有效提高氧分压,无明显加重二氧化碳蓄积的不良反应。

Application of Bag-valve-mask in COPD Patients after Ventilator Withdrawal

Objective To evaluate the efficacy of supplemental oxygen deliveU via Bag-valve-mask,regular face mask and nasal cannula in patients of COPD.Methods A total of 66 consecutive cases of COPD patients with severe respiratoW failure admitted from Jun.2010 to Jan.2013 were given mechanical ventilation support through tracheostomy cannula.All the cases were randomly divided into 3 groups：group 1 of using bag-valve-mask for oxygen delivmy after ventilator withdrawal; group 2 of using regular face mask ; group 3 of using nasal cannula.Frequency of ventilator reusing as well as PH,PaO2/FiO2 and PaCO2 at 24,48,72 h were analyzed after supplemental oxygen delivmy.Results （From group 1 to group 3） Number of ventilator reusing：2,6,8 people,Rate of ventilator reusing：9%,27%,36%.Besides,24,48 and 72 hrs after ventilator withdrawal,the partial pressure of carbon dioxide,the partial pressure of oxygen,and pH differences of the three groups were statistically significant （P 〈 0.05）.Conclusion Using bag-valve-mask in COPD patients can effectively improve the partial pressure of oxygen,and cause no significant increase of side effects of carbon dioxide accumulation.