无创正压通气对不同基础肺疾病合并Ⅱ型呼吸衰竭患者的疗效分析

目的:通过对无创正压通气(NIPPV)治疗非慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭与慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭患者的对比分析,了解NIPPV对非慢性阻塞性肺疾病所致Ⅱ型呼吸衰竭的治疗作用,评价NIPPV在治疗非慢性阻塞性肺疾病所致Ⅱ型呼吸衰竭中的治疗价值。方法:对比分析NIPPV对非慢性阻塞性肺疾病与AECOPD所致Ⅱ型呼吸衰竭的治疗效应。非慢性阻塞性肺疾病组18例,男12例,女6例,年龄(63.8±12.5)岁,其中职业性肺疾病10例(尘肺8例,石棉肺2例),脊柱后凸畸形或严重胸膜肥厚粘连5例,支气管扩张3例;AECOPD组33例,男26例,女7例,年龄(69.0±8.5)岁。结果:与NIPPV治疗前比较,非慢性阻塞性肺疾病组应用NIPPV治疗后第5天和出院前动脉血二氧化碳分压(PaCO2)显著下降(P<0.05);pH值在出院前显著改善(P<0.05);动脉血氧分压(PaO2)在应用NIPPV治疗后及出院时各时间点均显著升高(P<0.05)。在AECOPD组同NIPPV治疗前比,应用NIPPV治疗后各时间点和出院前PaCO2均显著下降(P<0.05),pH值显著改善(P<0.05);同NIPPV治疗前比,应用NIPPV治疗第2天、第3天、第5天和出院前PaO2显著升高(P<0.05)。结论:NIPPV对非慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭和AECOPD合并Ⅱ型呼吸衰竭均有较好的治疗效果。NIPPV治疗AECOPD所致Ⅱ型呼吸衰竭与非慢性阻塞性肺疾病相比,pH值和二氧化碳潴留改善得更快,而氧合在非慢性阻塞性肺疾病组改善得更快。NIPPV可用于非慢性阻塞性肺疾病所致Ⅱ型呼吸衰竭的抢救治疗。

Efficacy of non-invasive positive pressure ventilation on patients with type II respiratory failure secondary to acute exacerbations of chronic obstructive pulmonary disease or non chronic obstructive pulmonary disease

Objective To observe the efficacy of non-invasive positive pressure ventilation (NIPPV) on patients with type II respiratory failure secondary to acute exacerbations of chronic obstructive pulmonary disease (AECOPD) or non chronic obstructive pulmonary disease (non-COPD). Methods Eighteen patients with non-COPD (12 males and 6 females) (non-COPD group) with age (63.8 ± 12.5) years, among whom 10 patients with occupational lung disease (8 cases with pneumoconiosis, 2 cases with asbestosis), 5 patients with thoracocyllosis or severe thickening of pleura, and 3 cases with bronchiectasis, and 33 patients with AECOPD (AECOPD group) with age (69.0 ± 8.5) years were included in this study. All patients received NIPPV. The efficacy of NIPPV on patients in the two groups was compared. Results Arterial partial pressure of carbon dioxide (PaCO2) were significantly decreased on the fifth day after NIPPV and on the day prior to discharge (P < 0.05), pH was significantly elevated on the day prior to discharge, and arterial partial pressure of oxygen (PaO2) were significantly increased at every time point (P < 0.05) after NIPPV than before NIPPV in non-COPD group. In AECOPD group, PaCO2 was decreased and pH was increased significantly at every time point after NIPPV (P < 0.05), and PaO2 were raised significantly on the second day after NIPPV and afterwards (P < 0.05). Conclusion NIPPV were both effective in the treatment for patients with typeⅡ respiratory failure secondary to non-COPD or AECOPD. Carbon dioxide retention and acidosis were ameliorated more rapidly in AECOPD group, and oxygenation was improved more rapidly in non-COPD group.