无创正压通气治疗慢性阻塞性肺病合并Ⅱ型呼吸衰竭的临床研究

目的探讨早期应用无创正压通气(NIPPV)治疗慢性阻塞性肺病(COPD)合并Ⅱ型呼吸衰竭的临床疗效。方法将80例COPD合并Ⅱ型呼吸衰竭患者随机分为2组:对照组仅用常规治疗药物加常规鼻导管吸氧,试验组在常规药物治疗的基础上加用双水平无创正压通气(BiPAP)模式行NIPPV。观察比较2组治疗前后的临床指标和动脉血气情况。结果治疗后2组患者的呼吸频率(RR)、心室率(HR)、动脉血pH、p(O2)、p(CO2)和Sa(O2)均较治疗前明显改善(P<0.01)。与对照组比较,试验组治疗3 h,24 h和48 h后的pH、p(O2)和Sa(O2)上升更明显,p(CO2)下降更明显(P<0.01)。试验组和对照组的气管插管率分别为15%及38%(P<0.05);试验组的平均住院日较对照组明显缩短(P<0.05)。结论早期应用双水平无创正压通气能明显改善COPD合并Ⅱ型呼吸衰竭患者的临床体征及血气指标,降低插管率,缩短住院时间,是治疗COPD合并呼吸衰竭的有效手段。

Clinical study of noninvasive positive pressure ventilation on chronic obstructive pulmonary disease complicating with type II respiratory failure

Objective It is to evaluate the clinical effect of early use of noninvasive positive pressure ventilation(NIPPV) on chronic obstructive pulmonary disease(COPD) complicating with type II respiratory failure.Methods 80 cases of patients with COPD complicating with type II respiratory failure were divided randomly into 2 groups.The patients in control group were treated with conventional therapy and those in treatment group were treated with both conventional therapy and NIPPV with bilevel positive airway presur(BiPAP) mode.Clinical indexes and arterial blood gas parameters were observed before and after treatment.Result After treatment both the groups had significant improvement in respiratory rat,heart rat,pH,p(O2),p(CO2) and Sa(O2) compared with those before treatment(P<0.01).But improvements in pH,p(O2),and Sa(O2),p(CO2) in treatment group were more rapid and significant than those in control group at 3?h,24?h,48?h(P<0.01).The frequency of cannulas of treatment group and control group was respectively 14.6% and 38.4%(P<0.05).The average hospital time in treatment group was shorter than that in control group(P<0.05).Conclusions the early use of BiPAP for patients with COPD complicating with type IIrespiratory failure can rapidly improve clinical symptoms and arterial blood gas indexes,and reduce the frequency of cannulas and hospital time.It is a good and effective method to cure for COPD complicating with respiratory failure.