无创正压通气在慢性阻塞肺疾病伴严重Ⅱ型呼吸衰竭中的应用

目的探讨无创正压通气（NIPPV）治疗慢性阻塞性肺疾病（COPD）急性加重期伴重度Ⅱ型呼吸衰竭的疗效。方法选择COPD急性加重期伴重度Ⅱ型呼吸衰竭的病人20例,使用双水平无创正压呼吸机经口鼻面罩NIPPV治疗,动态观察治疗前和治疗后3、24h及治疗结束时的动脉血气、临床征象（神志、呼吸、心率）等。结果通气后3、24h及治疗结束时PaO2、pH明显上升（P〈0.05）,PaCO2、呼吸、心率明显下降（P〈0.01）,所有指标显著改善。16例患者成功脱机,有效率达80%（16/20）,2例改用有创通气,有创与无创序贯机械通气治疗后脱机成功,2例自动出院。结论双水平NIPPV治疗COPD急性加重期伴重度Ⅱ型呼吸衰竭的病人,可取得较好的疗效。

Application of non-invasive positive pressure ventilation in treatment of patients with COPD and severe respiratory failure

Objective To evaluate the efficacy of non-invasive positive pressure ventilation for treatment of chronic obstructive pulmonary disease（COPD） complicated with type-II respiratory failure.Methods 20 patients with COPD and complicated by severe type-II respiratory failure were treated by Bi-PAP ventilator in a noninvasive positive pressure ventilation（NPPV）.The change of arterial blood-gas analysis were measured and clinical sign（consciousness,respiratory rate,heart rate） were observed among these patients before and after ventilation at 3h, 24h and at the end of NPPV. Results After ventilation at 3h, 24h and at the end of NIPPV, the NIPPV increased PaO2 and PH significantly （ P 〈 0.05 ）, decreased PaCO2, respiratory rate and heart rate significantly （ P 〈 0.01 ）, and all index were improved. 16 patients weaned from the ventilator and discharged successfully. There were 2 patients were switched to sequential non - invasive ventilation and discharged, 2 gave up the treatment with aggravating state of illness. Conclusion The patients with COPD and complicated by severe type - II respiratory failure have more benefits from bi - level non - invasive positive pressure ventilation.