无创正压通气治疗中重度肺性脑病临床效果评价

目的 评价无创正压通气(NIPPV)应用于中重度肺性脑病患者的治疗效果.方法 将79例肺性脑病患者依格拉斯哥昏迷评分(GCS)分为8分＜GCS≤12分的中度肺性脑病组(A组)和GCS≤8分的重度肺性脑病组(B组),并给予无创通气治疗.结果 ①总成功率79.75%,其中A组80.85%,B组78.12%.②两组患者均在治疗1 h后,GCS、PaCO_2明显改善,PaO_2/FiO_2、pH、RR和HR于治疗2 h后明显改善.③失败组患者较成功组患者有更多的并发症发生率、较高的急性生理和慢性健康评分(Acute Physiology And Chronic Heahh Evaluation,APACHE-Ⅱ评分);A组患者以不耐受NIPPV治疗、面罩漏气为主;B组以血液动力学不稳定、气道保护能力差为主.④Logistic分析结果提示APACHE-Ⅱ评分、治疗1 h PaCO_2和GCS评分、2 h的RR、血液动力学状态、面罩漏气状况及气道保护能力与治疗成败存在相关性.结论 ①无创通气治疗肺性脑病是安全、有效的.②治疗后2 h患者的反应可以初步判断NIPPV疗效.③A组治疗过程中应关注患者主观的感受或面罩严密性;B组则需要关注患者的血液动力学情况或气道的保护能力.④APACHE-Ⅱ评分、无创通气治疗后1 h的GCS评分和PaCO_2、2 h后的RR及面罩漏气、血液动力学状态、气道保护能力可以预测中重度肺性脑病患者无创通气治疗的成败.

Evaluation of noninvasive positive pressure ventilation on middle to severe degree of hypercapnic coma

Objective To evaluate the effect of non-invasive positive pressure ventilation(NIPPV) on middle to severe degree of hypercapnic coma. Methods There were 79 patients enrolled and were classified into two groups as middle hypercapnic coma group (80.055. ②GCS, PaCO_2 had been improved after the 1 h posttherapy(P<0. 055 both in group A and group B,other variables such as PaO_2/FiO_2,pH, RR and HR showed significant improvement after 2 h post therapy (P<0.05).③The complication(P<0.05)and the acute physiology and chronic health evaluation(APACHE-Ⅱ)score(P<0.01)was higher in failure group than in success group,the main reasons of failure were the intolerance to NIPPV and mask leakage in group A, whereas hemodynamic instability and the poor ability of airway protection in group B(P<0.05).④ Logistic analysis showed that there were great significant relation between APACHE-Ⅱ score,GCS and PaCO_2after the 1 h posttherapy, RR after the 2 h posttherapy,hemodynamic state,mask leakage,and the ability of airway protection(P<0.05). Conclusions ①NIPPV could be used on the patients with hypercapnic coma secondary to AECOPD safely and effectively.②The response of the patients to NIPPV therapy after 2 h may predict the result of NIPPV therapy. ③ The patients,subjective feeling,mask leakage in group A and hemodynamie condition and airway protection in group B should be pay more attention to. ④Logistic analysis indicate that the APACHE-Ⅱ score, GCS after the 1 h posttherapy, RR after the 2 h posttherapy,mask leakage, hemodynamic state and the ability of airway protection could predict the effect of NIPPV therapy on middle to severe degree of hypercapnic coma.