无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的临床研究

目的探讨无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的疗效,旨在为临床寻找治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的有效方法提供参考依据。方法选择2009年1月~2013年1月来我院治疗的慢性阻塞性肺疾病急性加重期呼吸衰竭患者80例作为观察对象,两组均予抗感染、解痉、祛痰、纠正电解质紊乱及对症支持冶疗。治疗组同时应用BiPAP Symchrony呼吸机,经口鼻面罩进行NIPPV治疗;对照组应用鼻导管低流量通气治疗。观察比较:1)两组患者的临床疗效;2)两组患者通气前及通气后2h、24h、通气治疗结束时的pH、PaO2、PaCO2、SaO2的变化情况;3)两组患者气管插管机械通气率、病死率、平均住院时间及治疗期间发生的并发症等。结果治疗组患者治疗后的总有效率达90.0%,显著高于对照组(70.0%)(P<0.05)。治疗结束时,治疗组患者的pH、PaO2、SaO2、PaCO2较治疗前、通气后2h、通气后24h显著改善,差异有统计学意义(P<0.05)。且治疗组患者的pH、PaO2、SaO2、PaCO2较对照组改善更显著,差异均有统计学意义(P<0.05)。治疗组患者气管插管机械通气率5.0%,明显低于对照组,且治疗组患者的平均住院天数(11.7±3.9)d,明显短于对照组,治疗组患者的病死率2.5%,明显少于对照组,差异均有统计学意义(P<0.05)。结论无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭能提高临床疗效,提高患者的氧分压和氧饱和度,缩短住院时间、降低病死率、降低机械通气率,值得广泛推广和应用。

The clinical research of noninvasive positive pressure ventilation in threatment of chronic obstructive pulmonary disease with acute exacerbation of respiratory failure

Objective To investigate the effect of noninvasive positive pressure ventilation （NIPPV） in threatment ot chronic obstructive pulmonary disease with acute exacerbation of respiratory failure, aim to provide a reference for find an effective way in the clinical treatment of chronic obstructive pulmonary disease with acute exacerbation of respiratory failure. Methods From January to 2009 January 2013 in our hospital, chronic obstructive pulmonary disease with acute exacerbation of respiratory failure in 80 patients as an object of observation groups were treated anti-infectious, antispasmodic, expectorant, correct electrolyte imbalance and symptomatic and supportive cure. Treatment group while applying BiPAP Symchrony ventilator, through the nose and mouth mask for NIPPV treatment; control group was given low flow nasal cannula ventilation therapy. Observed and compared： 1）The clinical efficacy of two groups of patients; 2） Two groups of patients before and after ventilation ventilation 2 hours, 24 hours, ventilation therapy at the end of pH, PaO2, PaCO2, SaO2 changes. 3）Two groups of patients intubation and mechanical ventilation, mortality, average length significantly within the group, the difference was significant （P 〈 0.05）. And in patients treated with pH, PaO2, SaO2, PaCO2 compared with the control group improved more significantly between the two groups, the difference was significant（P 〈 0.05）. Patients treated with intubation and mechanical ventilation rate of 5.0%, was significantly lower than the control group, the treatment group patients had a mean hospital stay was （11.7±3.9）d, was significantly shorter than the control group, the mortality rate in patients treated was 2.5%, was significantly less than the control group, and the difference was significant （P 〈 0.05）. Conclusion Noninvasive positive pressure ventilation in chronic obstructive pulmonary disease with acute exacerbation of respiratory failure can improve clinical outcomes, improve the patient＇s oxygen partial pressure and oxygen saturation, shorter hospital stays and lower mortality, lower rates of mechanical ventila- tion, should be popularized and applied.