无创机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭

目的　研究无创 Bi- PAP呼吸机治疗慢性阻塞性肺疾病 (COPD)合并呼吸衰竭。方法　 6 2例患者随机分为治疗组 37例 ,持续 Bi- PAP呼吸机治疗 ;对照组 2 5例 ,持续低流量吸氧。两组同时抗感染等常规治疗。观察血气和临床症状变化。结果　治疗 7日后治疗组比对照组其 p H、Pa CO2 、Pa O2 差异具有显著性 (P<0 .0 1)。结论　COPD合并呼吸衰竭患者早期使用 Bi- PAP呼吸机治疗 ,对低氧血症和 CO2 潴留改善明显 ,疗效显著     

家庭无创机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭稳定期的临床研究

目的 探讨家庭无创机械通气治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并呼吸衰竭稳定期的可行性,观察其肺功能和血气变化.方法 选择2008年2月至2011年2月我科30例COPD合并呼吸衰竭住院患者,给予无刨机械通气,每日8～12 h,在治疗前后和稳定期分别检测血气分析、肺功能,一般4周为1疗程.通气模式:S/T IPAP(14～20 cm H2O) EPAP(3～5 cm H2O).其中10例COPD合并呼吸衰竭的患者好转出院后自购万曼双水平呼吸机ST22型,给予家庭无创机械通气,模式同上.其余患者出院后给予家庭氧气治疗.出院后半年复查血气和肺功能.结果 住院期间应用无创机械通气,30例患者血气和肺功能指标均显著改善,两组比较差异无统计学意义(P＞0.05).出院后半年,无创机械通气组和吸氧组复查肺功能和血气指标差异有统计学意义(P＜0.05),且住院次数分别为0次和15次.结论 家庭无创机械通气可改善患者的血气和肺功能,能减少其住院次数,提高生活质量.     

无创机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭的疗效

<正>慢性阻塞性肺疾病(OPD)是呼吸系统的常见病、多发病,因其病史时间长、住院次数多,给患者及家属带来了沉重的经济负担,严重影响了患者的日常生活,由于感染的诱因可使病情急剧加重,出现呼吸衰竭,如果药物保守治疗效果差、病情转重,就要面临机械通气治疗,有创机械通气患者痛苦大、费用高,患者及家属很难接受,而无创机械通气治疗具有费用小、无明显创伤,患者易摘、易戴、效果显著,且拥有易于接受等优点。收治无创机械通气患者进行疗效观察分析评价。     

无创机械通气在治疗慢性阻塞性肺疾病合并呼吸衰竭中的应用

目的探讨面罩无创正压机械通气(NIPPMV)治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的疗效。方法观察16例经过常规治疗效果不佳的COPD合并Ⅱ型呼吸衰竭患者应用NIPPMV治疗前、24h后临床疗效及血气变化。结果所有患者经无创机械通气治疗后病情明显好转,动脉血pH值恢复正常,动脉血PaO2高于NIPPMV治疗前水平(P<0.05),PaCO2低于NIPPMV治疗前水平(P<0.05)。结论无创正压通气对于COPD合并呼吸衰竭是一种切实有效的治疗措施。     

老年慢性阻塞性肺疾病合并呼吸衰竭应用无创机械通气的治疗效果

慢性阻塞性肺疾病合并呼吸衰竭多发生于老年患者,因为呼吸系统的局部防御功能减弱,老年患者肺功能储备减低,从而引发呼吸衰竭,预后极差[1].无创机械通气是一项非常重要的治疗方式.本文拟分析无创机械通气治疗对慢性阻塞性肺疾病合并呼吸衰竭的疗效. 1资料与方法 1.1 一般资料随机抽取2010年8月至2011年8月COPD急性发作合并Ⅱ型呼吸衰竭病患60例,男45例,女15例,年龄61 ～76岁,平均66岁.     

慢性阻塞性肺疾病患者长期家庭无创正压通气疗效观察

目的观察在重度慢性阻塞性肺疾病稳定期患者长期家庭无创正压通气（NPPV）治疗的疗效。方法慢性阻塞性肺疾病（COPD）合并慢性呼吸衰竭患者45例,随机分为治疗组20例和对照组25例,在病情的稳定期,治疗组给予长期家庭无创正压通气及常规治疗,对照组仅给予常规治疗。随访2～3年,观察两组治疗前后的每年平均急性加重次数、平均住院时间、平均住院费用、呼吸困难程度、血气指标及病死率的变化。结果两组患者的每年急性加重次数及病死率差异无统计学意义（P〉O．05）,住院时间、住院费用、血气指标中pH值均有显著差异沪〈0．05）,呼吸困难程度、PCO：有显著性差异（P〈0．01）。结论长期家庭无创正压通气治疗是重度慢性阻塞性肺疾病合并慢性呼吸衰竭稳定期患者有效的治疗手段。     

慢性阻塞性肺疾病并发呼吸衰竭的治疗

慢性阻塞性肺疾病(COPD)是呼吸系统的常见病和多发病,呼吸衰竭是COPD致死的主要原因,积极治疗呼吸衰竭具有重大意义.本文对氧疗、呼吸兴奋剂、机械通气在COPD急性加重期和稳定期呼吸衰竭的治疗作用及相关进展进行综述.     

无创机械通气和慢性阻塞性肺疾病

慢性阻塞性肺疾病 (COPD)是进行性气流受限的疾病 ,其发病率和死亡率均很高。无创机械通气(NIV)由于应用的便利及技术的提高 ,使得临床应用日趋广泛。NIV对COPD稳定期的应用尚无定论 ,但部分临床研究表明 ,对二氧化碳较高 ,伴有夜间睡眠紊乱呼吸的患者无创正压通气 (NIPPV)可能有益。对COPD急性加剧导致的急性呼衰 ,临床研究较一致表明对一部分选择的患者可以避免气管插管。     

无创机械通气和慢性阻塞性肺疾病

慢性阻塞性肺疾病（COPD）是进行性气流受限的疾病，其发病率和死亡率均很高，无创机械通气（NIV）由于应用的便利及技术的提高，使得临床应用日趋广泛，NIV对COPD稳定期的应用尚无定论，但部分临床研究表明，对二氧化碳较高，伴有夜间睡眠紊乱呼吸的患者无创正压通气（NIPPV）可能有益，对COPD急性加剧导致的急性呼衰，临床研究较一致表明对一部分选择的患者可以避免气管插管。     

BiPAP无创机械通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床分析

目的探讨应用无创机械通气治疗慢性阻塞性肺疾病（COPD）合并失代偿期呼吸衰竭的疗效。方法将COPD合并失代偿期Ⅱ型呼吸衰竭分为治疗组和对照组，各10例，记录生命体征、血气分析变化。结果通过4h、24h后2组比较，治疗组对提高PaO2和降低PaCO2与对照组比较，差异有显著性（P〈0．05）。结论BiPAP无创机械通气对COPD合并失代偿期Ⅱ型呼吸衰竭的治疗较好，可作为一线治疗手段。     

无创正压通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭近期疗效观察

目的探讨无创正压机械通气(NIPPV)在慢性阻塞性肺疾病(COPD)急性发作期合并Ⅱ型呼吸衰竭中的应用价值。方法64例COPD急性发作期合并呼吸衰竭患者随机分为对照组和治疗组。对照组给予常规治疗;治疗组除常规治疗外,加用NIPPV,通气时间5~7 d。比较两组同期血气分析及临床症状变化。结果治疗组血气、心率、呼吸频率等较对照组明显改善(P<0.01)。结论应用NIPPV可明显改善COPD急性发作期患者症状,提高PaO2,降低PaCO2,值得推广应用。     

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.     

BiPAP呼吸机治疗呼吸衰竭的疗效观察

目的 探讨BiPAP呼吸机在COPD合并呼吸衰竭的疗效。方法 18例COPD合并Ⅱ型呼吸衰竭患者在常规治疗基础上采用BiPAP呼吸机辅助通气作为治疗组，并取同期达同样标准而采用常规治疗的20例COPD患者作为对照组。结果 两组治疗后动脉血氧分压（PaO2)都明显上升（P＜0．01），但治疗组上升更高；治疗组血二氧化碳分压（PaCO2)比治疗前明显下降，治疗前后相差非常明显（P＜0．01），对照组PaCO2治疗前后相差不显著（P＞0．05）；治疗组临床症状缓解例数也明显多于对照组。结论：用BiPAP呼吸机辅助通气，对COPD合并轻，中度呼吸衰竭疗效肯定, 可降低PaCO2，提高PaO2，减轻症状，有利于呼吸肌疲劳恢复。     

Predictors of survival in COPD patients with chronic hypercapnic respiratory failure receiving noninvasive home ventilation

BACKGROUND: Patients with COPD and chronic hypercapnic respiratory failure (CHRF) are at high risk, and noninvasive ventilation at home is increasingly being used. Knowledge of prognostic parameters under these conditions is limited but may be clinically helpful and highlight the role of noninvasive ventilation. METHODS: In 188 patients with COPD (mean +/- SD FEV1, 31.0 +/- 9.6% of predicted; PaCo2, 56.3 +/- 9.4 mm Hg) discharged from the hospital receiving NIV between July 1994 and July 2004, the prognostic value of body mass index (BMI), lung function, laboratory parameters, and blood gas levels was assessed by univariate and multivariate Cox regression analyses. Moreover, the impact of changes in risk factors on mortality assessed 6.7 +/- 2.8 months after the initiation of noninvasive ventilation was evaluated. RESULTS: Overall, the mortality rate during follow-up (duration, 32.2 +/- 24.3 months) was 44.7%, with 1-year, 2-year, and 5-year survival rates of 84.0%, 65.3%, and 26.4%. Deaths resulted predominantly from respiratory causes (73.8%). Univariate regression analyses revealed age, BMI, hemoglobin, FEV1, specific airway resistance, residual volume (RV)/total lung capacity (TLC), pH, and base excess (BE) to be associated with prognosis (p < 0.01 each), whereas multivariate analysis identified only age, BMI, RV/TLC, and BE as independent predictors (p < 0.05). In patients at risk (BMI < 25 km/m2, RV/TLC >or= 73%, or BE >or= 9 mmol/L), changes in these predictors were also associated with survival. CONCLUSIONS: In patients with COPD and CHRF, nutritional status, hyperinflation, and BE, which turned out to be reliable and consistent markers in CHRF, were independent prognostic factors for mortality. These data favor a multidimensional approach in these patients, including the use of noninvasive ventilation.     

有创与无创序贯性机械通气治疗慢性阻塞性肺疾病所致严重 …

OBJECTIVE: To estimate the feasibility and the efficacy of early extubation and sequential non-invasive mechanical ventilation(MV) in COPD with exacerbated hypercapnic respiratory failure. METHODS: 22 intubated COPD cases with severe hypercapnic respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. At the time pulmonary infection had been significantly controlled (resolution of fever and decrease in purulent sputum, radiographic infiltrations, and leukocytosis. We call the time as "Pulmonary Infection Control Window", PIC window) after the antibiotic and the comprehensive therapy, the early extubation was conducted and followed by non-invasive MV via facial mask immediately in 11 cases (study group). Other 11 COPD cases with similar clinical characteristics who continuously received invasive MV after PIC window were used as control group. RESULTS: The groups had similar clinical characteristics and gas exchange, initially and at the time of PIC window. For study group and control group, the duration of invasive MV was (7.1 +/- 2.9) vs (23.0 +/- 14.0) days, P < 0.01; the total duration of ventilatory support was (13 +/- 7) vs (23 +/- 14) days, P < 0.05; the incidence of VAP were 0/11 vs 6/11, P < 0.01; the duration of ICU stay was (13 +/- 7) vs (26 +/- 14) days, P < 0.05, respectively. CONCLUSIONS: In COPD patients requiring intubation and MV for pulmonary infection and hypercapnic respiratory failure, early extubation followed by non-invasive MV initiated at the point of PIC window may significantly decrease the invasive and total durations of ventilatory support, the risk of VAP, and the duration of ICU stay.     

Improvement of right ventricular systolic performance by long-term domiciliary oxygen therapy in patients with chronic respiratory failure

Eight patients with clinically stable chronic respiratory failure, hypoxemia (PaO2 less than or equal to 60 mmHg) and pulmonary hypertension (mean pulmonary arterial pressure greater than or equal to 20 mmHg) were allocated to long-term domiciliary oxygen therapy, and were followed for three months. Oxygen was supplied for from 15 to 18 hours daily from an oxygen concentrator at a flow rate sufficient to raise the PaO2 to 60 to 80 mmHg. We examined the effects of this therapy on right ventricular performance both at rest and during exercise in these patients. Hemodynamic data were obtained by right heart catheterization. Right ventricular ejection fractions (RVEF) were ascertained using first-pass quantitative radionuclide 81mKr angiocardiography. Thirty minutes of oxygen inhalation at rest had no significant effect on cardiac function, both before therapy (T0) and after 3 months of therapy (T1). The mean pulmonary arterial pressure and the pulmonary vascular resistance during exercise were not significantly different between T0 and T1. On the other hand, at T0, the RVEF tended to decrease from 51.6 +/- 4.9% (during oxygen inhalation at rest) to 48.7 +/- 7.9% (during exercise), whereas at T1 it significantly (p less than 0.05) increased from 48.8 +/- 6.8% (during oxygen inhalation at rest) to 54.2 +/- 8.2% (during exercise). Thus, while 3 months of long-term domiciliary oxygen therapy did not reduce the right ventricular afterload either at rest or during exercise, it was found to improve the right ventricular systolic performance during exercise. This suggested that long-term oxygen therapy could be useful in improving the quality of daily life of patients with chronic respiratory failure.     

Predictors of survival in patients with chronic hypercapnic respiratory failure receiving domiciliary NPPV

Fifty-four cases (36 men) with chronic hypercapnic respiratory failure were prescribed domiciliary NPPV during 9 years. COPD (26 patients) and sequelae of tuberclosis (16 patients) were the major primary diseases. At the initiation of NPPV, the age was 71.2 +/- 7.3 years-old (mean +/- standard deviation) and PaCO2 was 76.7 +/- 16.2Torr. Overall, the 1-year and 5-year survival rates were 63.8% and 26.0%, respectively. Multivariate analysis identified BMI (body mass index) (hazzard ratio : 0.837, p = 0.020) and the number of days of hospitalization during 1 year before NPPV (hazzard ratio: 1.013, p = 0.016) as predictors of survival. Patients with frequent hospitalization for exacerbation or with malnutrition had poor prognosis, so comprehensive supports aimed to improve general status are needed for patients with chronic respiratory failure received domiciliary NPPV.     

The effects of long-term oxygen therapy on survey in patients with chronic respiratory failure

Long-term (> or = 15 hours) oxygen therapy (LTOT) increases life-span and improves quality of life (QOL) in patients with chronic respiratory failure (CRF). However, in our clinical practice, we observed that very few patients are using oxygen therapy 15 hours or more. Furthermore, very few literatures about survival of non- or inadequate oxygen users were found. Thus, the aim of this study was to assess the effect of LTOT in patients with CRF. A total of 305 LTOT recommended patients with CRF in our clinic between 1996 and 2001 were found. A hundred and five patients with documented subject characteristics were included the study and followed-up approximately 20 months prospectively. They were divided into two groups whether to take LTOT (group 1, n= 71) or not (group 2, n= 34). Average life-span of the patients was 50 months in group 1 and 39 months in group 2 (p< 0.05). Survival (months) in group 1 was significantly correlated with hrs of oxygen use (r= 0.684, p= 0.001). One more hour oxygen use was statistically significantly correlated with 0.002 months more survival (F= 48.44, p< 0.05) in group 1 in logistic regression analysis. In comparisons, there were significant improvement in the post-treatment blood gas values in group 1 (p< 0.05). There were significant decreases in PFT values in the post-treatment period when compared to baseline values in both groups (p< 0.05). There was a less decrease in FEV(1) values per year in group 1 than group 2 but difference was not statistically significant (p> 0.05). In conclusion our findings revealed that LTOT provides improvement of the life-span of the patients with CRF.