无创通气对清醒状态慢性阻塞性肺疾病患者呼吸动力的影响

目的 探讨无创正压通气(NIPPV)对清醒状态慢性阻塞性肺疾病(COPD)患者呼吸动力的影响.方法 选择19例COPD急性加重期住院患者,治疗后病情稳定,通过食道-胃囊管法,检测气道开口压、食道压和胃内压,层流速仪测呼吸流速和容量改变.监测患者在清醒状态下自主呼吸及NIPPV时呼吸动力的变化.结果 ①对呼吸流速和肺通气的影响:吸气峰流速(PIF)、平均吸气流速(VT/Ti)、潮气量(VT)、分钟通气量(VE)在自主呼吸及NIPPV时,两组间变化差异无统计学意义.②对上气道阻力(Rua)和动态肺顺应性(CLdyn)的影响:自主呼吸时Rua(15.07±3.62)cm H2O·L-1·s-1、CLdyn(0.052±0.012)L/cm H2O,与自主呼吸比较,NIPPV时Rua减少6.91%(P＞0.05)、CLdyn增加44.23%(P＞0.05).③对呼吸肌肉活动和呼吸努力的影响:自主呼吸时跨膈压(Pdi)(19.85±4.00)cm H2O、食道负压(Pes)(-13.37±3.77)cm H2O,压力时间乘积(PTP)(287.79±95.14)cm H2O·s/min,与自主呼吸比较,NIPPV时Pdi下降61.96%(P＜0.001),Pes负压减少67.83%(P＜0.001),PTP下降58.80%(P＜0.01).结论 NIPPV对清醒状态COPD患者吸气流速、肺通气量及上气道阻力无明显影响;NIPPV有效的降低了呼吸肌肉活动,减少呼吸努力,改善呼吸肌疲劳.     

Non-invasive positive pressure ventilation (NIPPV) in stable patients with chronic obstructive pulmonary disease (COPD)

While non-invasive positive pressure ventilation (NIPPV) has become an accepted management approach for patients with acute hypercapnia, it remains unclear whether it can also be beneficial in stable chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. Randomised controlled trials (RCT) with a maximum duration of 3 months showed contradictory effects in blood gasses, dyspnoea, sleep efficiency and health-related quality of life. On the other hand, several uncontrolled trials did show positive results in patients with hypercapnia. Recently, an RCT compared the combination of NIPPV and long-term oxygen treatment (LTOT) with LTOT alone for a period of 2 years in hypercapnic patients. After this period dyspnoea decreased and health-related quality of life improved in the NIPPV compared to the LTOT group. Reasons for the contradictory results in the different trials are probably patient selection, adequacy of ventilation, and length of ventilation. Therefore, at this moment there is no conclusive evidence that NIPPV should be provided routinely to stable patients with COPD. However, a selected group of patients might have clinical benefits from it. Patients who are clearly hypercapnic, who can tolerate an effective level of ventilatory support, and who get enough time to adjust to the ventilator might show clinical benefits even after 3 months. A trial with ventilatory support in this group of patients can be considered.     

无创正压机械通气对慢性阻塞性肺疾病急性加重期呼吸衰竭的救治

目的进一步评价和认识无创正压机械通气在救治慢性阻塞性肺疾病(COPD)严重呼吸衰竭中的地位和作用。方法前瞻性研究了25例COPD急性加重期患者,均伴有严重的Ⅱ型呼吸衰竭(PaCO2>80mmHg),应用无创双水平正压通气治疗,监测血气、通气参数、临床转归等情况。结果无创机械通气治疗有效22例,治疗开始后1小时血气无明显改变,3小时PaCO2显著下降(P<0.05),pH值上升(P<0.05),病情改善。其中少数患者PaCO2>100mmgH、或伴有昏迷,无创通气抢救成功。患者对鼻面罩及正压通气接受性良好,副作用少。结论无创机械通气为抢救COPD合并呼吸衰竭提供了有效的手段。     

无创正压通气救治慢性阻塞性肺疾病合并严重Ⅱ型呼吸衰竭的临床研究

目的 评价无创正压通气（NIPPV）救治慢性阻塞性肺疾病（COPD）合并严重Ⅱ型呼吸衰竭的治疗效果。方法 前瞻性研究25例伴严重Ⅱ型呼吸衰竭（PaCO2〉80mmHg）的COPD急性发作期患者，在常规治疗基础上给予NIPPV治疗，并监测血气、临床征象等情况。结果 NIPPV3h迅速改善了患者的心率（HR）、呼吸频率（RR）和血气（PH、PaCO2）（P〈0.01），通气24h可获进一步改善（P〈0.01）。插管率12%，病死率8%。结论 NIPPV是治疗COPD合并严重Ⅱ型呼吸衰竭的有效手段。     

家庭无创正压机械通气联合康复锻炼对慢性阻塞性肺疾病患者呼吸肌肌力的影响

目的评估家庭无创正压机械通气联合康复锻炼对稳定期重度慢性阻塞性肺疾病（COPD）患者呼吸肌肌力的影响。方法将56例经住院治疗处于稳定期的重度COPD患者分为无创呼吸机＋呼吸操组（治疗组,n=26）和无创呼吸机组（对照组,n=30）。分别观察治疗前、治疗后2年两组患者的最大吸气压（MIP）、跨膈压（Pdi）、最大跨膈压（Pdimax）及Pdi/Pdimax、CO_2分压（PaCO_2）、肺功能、6min行走距离（6MWD）、病死率及再住院率等指标。结果两组年龄、性别、COPD病程、体质量指数、PaCO_2、PaO_2、MIP、Pdi、Pdimax及Pdi/Pdimax、第一秒用力呼气容积实测值与预计值的比值（FEV_1%）、第一秒用力呼气容积占用力肺活量比值（FEV_1/FVC%）、6MWD和每年住院次数均具有可比性（均P〉0.05）。2的年后治疗组MIP,Pdi,Pdimax及Pdi/Pdimax,6MWD,每年住院次数分别为（76±6）cmH_2O,（48±5）cmH_2O,（126±11）cmH_2O,（0.38±0.01）,（263±33）m和（2.1±0.9）次/年,与对照组[（72±5）cmH_2O,（45±4）cmH_2O,（116±8）cmH_2O,（0.39±0.02）,（244±26）m,（2.6±0.9）次/年]比较均具有统计学意义（均P〈0.05）。治疗组死亡1例（1/26）,对照组2例（2/30）,两组比较差异无统计学意义（χ~2=0.02,P〉0.05）。结论长期家庭无创正压机械通气联合呼吸操康复锻炼治疗可以有效提高稳定期重度COPD患者呼吸肌肌力及呼吸肌耐力,改善运动功能,从而达到更好的长期治疗效果。     

Noninvasive mechanical ventilation in patients with stable severe COPD

Noninvasive positive pressure ventilation in patients with stable chronic obstructive pulmonary disease. The role of non-invasive positive pressure ventilation (NIPPV) is well documented in patients with restrictive thoracic diseases like kyphoscoliosis, tuberculosis sequelae or neuromuscular disease. There is also a good evidence for the use of NIPPV in acute respiratory failure in patients with an exacerbation of COPD. The application of NIPPV in patients with chronic respiratory failure is growing, but there is less evidence than in restrictive disorders. NIPPV can unload the respiratory muscles in patients with chronic hypercapnic COPD and so alleviates fatigue of the respiratory pump, but improvement in the maximal inspiratory pressure (Pi (max)) is small or even absent. An improvement of sleep quality has also postulated, there was an increase in total sleep time and sleep effectiveness when using higher inspiratory pressure. An increase of the walking distance was shown in short term studies, only. In most studies, there was an increase in quality of life as a main topic. Mortality was unchanged in the two long-term randomised controlled studies. Current data suggest a possible role of NIPPV in patients with severe hypercapnia. A high effective inspiratory pressure and a ventilator mode with a significant reduction in the work of breathing should be choosen. NIPPV should be started in hospital, a close reassessment must be performed. Patients who accepted NIPPV in the first weeks had a good compliance for long-term use.     

Noninvasive positive-pressure ventilation in an elderly woman with acute respiratory failure caused by influenza a virus pneumonia]

A 79-year-old woman was admitted on January 18, 2000, with a lumbar compression fracture. Two days after admission, a chest X-ray film showed reticular infiltrates in the right lung field. She was diagnosed as having pneumonia and was treated with antibiotics. Despite this therapy, her symptoms did not improve and the infiltrates diffusely extended to involve both lungs on chest X-ray films. She was placed on noninvasive positive pressure ventilation (NIPPV) for progressive respiratory failure at 5 days after admission in order to avoid endotracheal intubation. Her hypoxemia was immediately improved by oronasal bilevel positive airway pressure ventilation (BiPAP) and chest X-ray films revealed improvement of the reticular infiltrates. Measurement of viral antibody titers showed that the cause of acute respiratory failure was influenza A virus pneumonia. In conclusion, NIPPV may reduce the need for intubation of elderly patients with acute respiratory failure, as well as chronic obstructive pulmonary disease (COPD) patients.     

无创正压通气治疗慢性阻塞性肺疾病并发呼吸衰竭的临床价值

目的评价无创正压通气(NIPPV)对慢性阻塞性肺疾病(COPD)急性加重期并发呼吸衰竭的治疗价值。方法选择接受NIPPV的COPD患者28例,以同期同样标准COPD患者32例作为对照组(常规治疗组),动态观察两组患者通气、氧合、心率、呼吸频率等改善情况。结果NIPPV治疗组同期血气、心率、呼吸频率等较对照组明显改善(P均<0.05)。NIPPV治疗组插管率、病死率、住院时间较常规治疗组(对照组)均明显降低(P<0.05),临床有效率较对照组明显升高(P<0.05)。结论NIPPV治疗COPD急性加重期伴呼吸衰竭疗效确切、安全,减轻症状,减少气管插管率,促进患者康复。     

A meta-analysis of nocturnal noninvasive positive pressure ventilation in patients with stable COPD

STUDY OBJECTIVES: The potential benefits of noninvasive positive pressure ventilation (NIPPV) for patients with COPD remains inconclusive, as most studies have included only a small number of patients. We therefore undertook a meta-analysis of randomized controlled trials (RCTs) that compared nocturnal NIPPV with conventional management in patients with COPD and stable respiratory failure. DESIGN: RCTs were identified from several sources, such as MEDLINE, EMBASE, and CINAHL. In addition, records were identified through hand searching of abstracts from meetings of the American Thoracic Society, the American College of Chest Physicians, and the European Respiratory Society. PATIENTS: Patients with COPD according to the definition of the American Thoracic Society. INTERVENTIONS: NIPPV applied via a nasal or facemask for at least 5 h/d for at least 3 weeks. Patients in the actively treated group continued to receive the usual management for COPD. The control group received the same management as the study group but did not receive NIPPV. Measurements and results: PaCO(2), PaO(2), 6-min walking distance (6MWD), respiratory muscle function, FEV(1), vital capacity, and sleep efficiency (time asleep as a percentage of total time in bed) were used as outcome measures. The publications were reduced to 10 potentially eligible articles from 164 publications retrieved from computer searches and 8 further abstracts. Four trials were finally included in the meta-analysis. The only outcome for which the confidence intervals excluded zero was maximal inspiratory pressure (PImax). The confidence intervals for the other outcomes included zero. The mean treatment effects for FEV(1) and PImax were small, whereas it was moderate for the 6MWD. Small negative effects were found for the outcomes of vital capacity, PaCO(2), and sleep efficiency. CONCLUSIONS: This meta-analysis of 3 months of NIPPV in patients with stable COPD showed that ventilatory support did not improve lung function, gas exchange, or sleep efficiency. The high upper limit of the confidence interval for the 6MWD suggested that some people do improve their walking distance. The small overall sample size precluded a clear clinical direction regarding the effects of NIPPV in patients with COPD.     

Health-related quality of life in patients with chronic respiratory failure after long-term mechanical ventilation

STUDY OBJECTIVES: This study was aimed at assessing health-related quality of life (HRQL) in patients with chronic respiratory failure (CRF) and long-term survival following prolonged intensive care mechanical ventilation. DESIGN: Observational cohort study. SETTING: Patients with CRF who had been transferred to our specialized weaning centre due to prolonged mechanical ventilation (>14 days) and weaning failure. PATIENTS AND PARTICIPANTS: Out of 87 long-term survivors (>6 months), 73 patients (mean age: 60.3+/-13.6 years, chronic obstructive pulmonary disease (COPD, 43%), thoraco-restrictive (21%) or neuromuscular disorders (15%), various chronic diseases (22%)) returned the MOS 36-Item Short-Form Health Status Survey (SF-36) and the St. George's respiratory questionnaire (SGRQ). MEASUREMENTS AND RESULTS: The total ventilation time was 38.7+/-45.9 days. The time between discharge from ICU and HRQL assessment was 31.0+/-22.2 months. Physical health was markedly reduced compared to general population norm, but mental health was mildly impaired. HRQL was comparable to patients with stable CRF receiving non-invasive ventilation who did not need prolonged invasive MV. In addition, general HRQL was better in patients with restrictive respiratory disease compared to patients with neuromuscular diseases (P<0.05). Physiological parameters such as blood gases or lung function parameters were not correlated to any HRQL measurements. CONCLUSIONS: In patients with CRF surviving prolonged ventilation on ICU, the presence of CRF itself is the major determinant of HRQL. Here, the underlying cause of CRF is the major factor which determines the degree of HRQL impairment with patients suffering from restrictive ventilatory disorders reporting the best HRQL when compared to patients with COPD or neuromuscular diseases. Despite severe physical handicaps due to CRF mental health is only mildly compromised.     

The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) patients with chronic ventilatory failure (CVF) are more likely to develop exacerbations, which are an important determinant of health-related quality of life (HRQL). Long-term noninvasive positive-pressure ventilation (NPPV) has been proposed in addition to long-term oxygen therapy (LTOT) to treat CVF but little information is available on its effects on HRQL and resource consumption. Therefore, the current authors undertook a 2-yr multicentric, prospective, randomised, controlled trial to assess the effect of NPPV+ LTOT on: 1) severity of hypercapnia; 2) use of healthcare resources, and 3) HRQL, in comparison with LTOT alone. One hundred and twenty-two stable hypercapnic COPD patients on LTOT for > or = 6 months were consecutively enrolled. After inclusion and 1-month run-in, 90 patients were randomly assigned to NPPV+LTOT (n=43) or to LTOT alone (n=47). Arterial blood gases, hospital and intensive care unit (ICU) admissions, total hospital and ICU length of stay and HRQL were primary outcome measures; survival and drop-out rates, symptoms (dyspnoea and sleep quality) and exercise tolerance were secondary outcome measures. Follow-up was performed at 3-month intervals up to 2 yrs. Lung function, inspiratory muscle function, exercise tolerance and sleep quality score did not change over time in either group. By contrast the carbon dioxide tension in arterial blood on usual oxygen, resting dyspnoea and HRQL, as assessed by the Maugeri Foundation Respiratory Failure Questionnaire, changed differently over time in the two groups in favour of NPPV+LTOT. Hospital admissions were not different between groups during the follow-up. Nevertheless, overall hospital admissions showed a different trend to change in the NPPV+LTOT (decreasing by 45%) as compared with the LTOT group (increasing by 27%) when comparing the follow-up with the follow-back periods. ICU stay decreased over time by 75% and 20% in the NPPV+LTOT and LTOT groups, respectively. Survival was similar. Compared with long-term oxygen therapy alone, the addition of noninvasive positive-pressure ventilation to long-term oxygen therapy in stable chronic obstructive pulmonary disease patients with chronic ventilatory failure: 1) slightly decreased the trend to carbon dioxide retention in patients receiving oxygen at home and 2) improved dyspnoea and health-related quality of life. The results of this study show some significant benefits with the use of nocturnal, home noninvasive positive-pressure ventilation in patients with chronic ventilatory failure due to advanced chronic obstructive pulmonary disease patients. Further work is required to evaluate the effect of noninvasive positive-pressure ventilation on reducing the frequency and severity of chronic obstructive pulmonary disease exacerbation.     

无创正压通气抑制慢性阻塞性肺疾病急性加重期患者吸气肌肉活动的机制

目的探讨无创正压通气（NIPPV）抑制慢性阻塞性肺疾病（COPD）急性发作期患者吸气肌肉活动的机制。方法12例COPD急性加重期患者接受感觉最舒适通气压力水平时的NIPPV,观察患者吸气肌肉用力和呼吸方式的变化。结果与自主呼吸（SB）相比,NIPPV时的潮气量（VT）显著增高（从408ml升到462ml,P〈0.05）;接受NIPPV后VT的增高很迅速,第一呼吸周期时即明显增高。SB时的跨膜压（Pdi）为14.04cmH2O,而NIPPV时为10.98cmH2O,比SB时约减少22%（P〈0.05）。NIPPV时Pdi的下降从第一个呼吸周期即开始,然后进一步迅速下降,治疗至第5个呼吸周期时与SB时相比开始有显著差异（P〈0.05）。SB时的呼吸肌做功（Wp）分别为0.47J/breath和0.95J/L;而NIPPV时分别为0.34J/breath和0.69J/L,比SB时分别减少28%和27%（P〈0.05）。NIPPV时Wp的下降也是从第一个呼吸周期即开始,然后进一步迅速下降,治疗至第5个呼吸周期时与SB时相比开始有显著差异（P〈0.05）。结论本实验证实了NIPPV治疗COPD急性加重期患者时吸气肌肉活动的非化学性抑制作用的存在;这种非化学性抑制作用的产生与NIPPV治疗的开始基本同步,能有效改善患者的呼吸肌肉疲劳。     

无创正压通气治疗稳定期慢性阻塞性肺疾病的疗效

无创正压通气(noninvasive positive pressure ventilation,NPPV)在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重期和稳定期患者中都有广泛应用.对于急性加重期患者,NPPV可显著降低气管插管率、病死率、住重症监护病房(ICU)时间及住院时间等.对于稳定期患者,NPPV能显著改善呼吸困难症状及部分肺功能指标、提高PaO2水平、缓解呼吸肌疲劳、增强活动耐力以及改善睡眠和生活质量,但对于NPPV能否显著降低PaCO2水平,降低住院率、病死率、住ICU时间以及住院时间等,尚存在较大争议.充分了解NPPV在稳定期COPD患者中的疗效,对于提高NPPV的临床应用水平具有重要意义.     

慢性阻塞性肺疾病患者运动耐力下降的生理学研究

目的研究平板踏车联合无创正压通气（NIPPV）运动锻炼对COPD患者呼吸生理学的影响,探讨与运动耐力改善相关的生理学机制,期望为COPD患者呼吸康复提供新的更为有效的方法。方法按2011年修订版GOLD标准选择稳定期重度至极重度COPD患者为研究对象,分为3组：即平板踏车联合NIPPV运动锻炼组（A组）、平板踏车运动锻炼组（B组）、既无NIPPV又无平板踏车运动锻炼组（C组）,每组观测20例。在运动锻炼前后分别测定6MWD、MRC评分、MEP、MIP及肺通气功能。结果经平板踏车联合NIPPV运动锻炼后COPD患者6MWD、MEP、MIP明显增加（P〈0．01）,MRC评分明显降低（P〈0．01）,肺功能FEV1％pred、FEV1／FVC、MVV、PEF等指标稍有改善,但锻炼前后差异无统计学意义（P〉0．05）;而MVV则有明显改善（P〈0．01）,差异具有统计学意义。结论重度至极重度稳定期COPD患者在平板踏车上进行面罩NIPPV运动锻炼有助于改善其运动耐力和吸气肌力,缓解呼吸困难,是一种较好的适合于重度至极重度稳定期cOPD患者的呼吸康复锻炼方法。     

The clinical management in extremely severe COPD

Chronic obstructive pulmonary disease (COPD) affects 6% of the general population and is the fourth-leading cause of death in the United States with severe and very severe disease accounting for 15% and 3% of physician diagnoses of COPD. Guidelines make few recommendations regarding providing the provision of care for the most severe stages of disease, namely Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV with chronic respiratory failure. The effectiveness of inhaled drug therapy in very severe patients has not been assessed yet. Health care systems in many countries include public funding of long-term oxygen therapy for eligible candidates. Currently, there is little evidence for the use of mechanical ventilatory support in the routine management of hypercapnic patients. Pulmonary rehabilitation should be considered as a significant component of therapy, even in the most severe patients. Although Lung Volume Reduction Surgery has been shown to improve mortality, exercise capacity, and quality of life in selected patients, this modality is associated with significant morbidity and an early mortality rate in the most severe patients. Despite significant progress over the past 25 years, both short- and long-term outcomes remain significantly inferior for lung transplantation relative to other "solid" organ recipients. Nutritional assessment and management is an important therapeutic option in patients with chronic respiratory diseases. Morphine may significantly reduce dyspnoea and does not significantly accelerate death. No consistent improvement in dyspnoea over placebo has been shown with anxiolytics. Supplemental oxygen during exercise reduces exertional breathlessness and improves exercise tolerance of the hypoxaemic patient. Non-invasive ventilation has been used as a palliative treatment to reduce dyspnoea. Hypoxaemic COPD patients, on long-term oxygen therapy, may show reduced health-related quality of life, cognitive function, and depression. Only a small proportion of patients with severe COPD discuss end-of-life issues with their physicians.     

Respiratory muscle activity in patients with COPD walking to exhaustion with and without pressure support.

The function of the diaphragm and other respiratory muscles during exercise in chronic obstructive pulmonary disease (COPD) remains controversial and few data exist regarding respiratory muscle pressure generation in this situation. The inspiratory pressure/time products of the oesophageal and transdiaphragmatic pressure, and the expiratory gastric pressure/time product during exhaustive treadmill walking in 12 patients with severe COPD are reported. The effect of noninvasive positive pressure ventilation during treadmill exercise was also examined in a subgroup of patients (n=6). During free walking, the inspiratory pressure/time products rose early in the walk and then remained level until the patients were forced to stop because of intolerable dyspnoea. In contrast, the expiratory gastric pressure/time product increased progressively throughout the walk. When patients walked the same distance assisted by noninvasive positive pressure ventilation, a substantial reduction was observed in the inspiratory and expiratory pressure/time products throughout the walk. When patients walked with positive pressure ventilation for as long as they could, the pressure/time products observed at exercise cessation were lower than those observed during exercise cessation after free walking. It is concluded that, in severe chronic obstructive pulmonary disease, inspiratory muscle pressure generation does not increase to meet the demands imposed by exhaustive exercise, whereas expiratory muscle pressure generation rises progressively. Inspiratory pressure support was shown to substantially unload all components of the respiratory muscle pump.     

无创通气对慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床疗效

目的探讨无创通气对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者的临床疗效。方法选取我院2010年4月—2011年10月收治的60例COPD合并Ⅱ型呼吸衰竭的患者,随机分为观察组和对照组各30例。在常规治疗的基础上,观察组采用无创正压通气,对照组使用鼻导管吸氧。观察两组治疗前后的症状改变及血气变化、死亡率。结果观察组PaO2的升高和PaCO2下降幅度都较对照组明显(P<0.05)。观察组死亡率为6.67%,明显低于对照组的20.00%。结论无创正压通气能有效改善COPD合并呼吸衰竭患者的血气指标,提高生存率,值得在临床推广应用。     

Impact of acute respiratory failure on survival of COPD patients managed with long-term non-invasive ventilation and oxygen therapy

Our study aimed to assess the impact of acute respiratory failure (ARF) on survival of patients with chronic obstructive pulmonary disease (COPD) receiving long-term oxygen therapy (LTOT) plus nasal intermittent positive pressure ventilation (NIPPV). Survival was analysed retrospectively in 24 patients with severe COPD initiated to NIPPV in addition to LTOT. Fourteen patients were established on NIPPV following exacerbation of acute respiratory failure which has required mechanical ventilation (group 1). Ten patients (group 2) have never been hospitalized for ARF. Comparison of clinical details at baseline, 6 months, 1, 2, and 3 years for the two groups failed to reveal any difference with the exception of prior episodes of ARF. The probability of survival at 3 years was 65% (95% confidence interval [CI] 43-86) for the overall population, 46% (95% CI 15-77) in group 1, and 74% (95% CI 42-105) in group 2. The difference between the two groups was statistically significant. We show that ARF requiring mechanical ventilation appears to be a factor that is negatively correlated with survival for patients treated by LTOT plus NIPPV. This data suggests that NIPPV should be tried before ARF arising in COPD patients who present a deterioration in chronic respiratory failure with hypercapnia.     

无创呼吸机治疗COPD伴重度CO2潴留的疗效观察

目的探讨无创机械通气在慢性阻塞性肺病伴重度CO2潴留患者中的治疗效果。方法回顾性分析2005年12月到2007年10月我科收治的30例COPD病人资料，均为PaCO2〉80mmHg的COPD伴Ⅱ型呼衰患者，在常规药物治疗及氧疗基础上应用无创呼吸机辅助通气（NIPPV）治疗，通过自身对照观察患者NIPPV治疗前、后血气指标变化和病情改善程度。结果30例患者中2例不能耐受无创通气，放弃治疗，24例使用无创后好转，病情稳定出院，4例无创通气失败，改行气管插管，死亡2例。NIPPV治疗有效患者2h后血气指标明显改善，PaCO2显著下降（P〈0．001），48h后病情明显好转。结论无创正压机械辅助通气可显著改善COPD伴重度高碳酸血症患者，疗效肯定。     

无创正压机械通气治疗慢性阻塞性肺疾病失败病例分析

目的探讨无创正压机械通气（NIPPV）治疗慢性阻塞性肺疾病（COPD）伴Ⅱ型呼吸衰竭失败病例的相关因素,为NIPPV临床应用提供可能的依据。方法将91例COPD患者分为成功组和失败组。监测两组患者的生命体征、血气分析、血常规、电解质、肝肾功能等指标,多因素分析患者年龄、呼吸衰竭病程、合并症。观察患者的依从性、上机后开始床旁监测时间、应用呼吸机早期病情的变化。结果在NIPPV早期依从性方面,失败组明显低于成功组,失败组初次使用呼吸机的监护时间明显低于成功组。在APACHEⅡ评分方面,失败组明显高于成功组。两组初始血气分析指标比较无明显差异。但随着通气时间的延长,成功组明显好转,而失败组无明显变化。NIPPV在抢救COPD引起的呼吸衰竭成功率为74．72％,两组其余指标比较差异有统计学意义。结论NIPPV在抢救COPD伴Ⅱ型呼吸衰竭有重要的临床价值,使用NIPPV可早期监测患者的病情变化。