早期应用无创通气治疗急性加重期COPD的研究

目的探讨无创正压通气（NIPPV）早期应用治疗急性加重期慢性阻塞性肺疾病（COPD）的指征和价值.方法采用前瞻性随机对照研究将90例COPD患者随机分为标准治疗对照组和标准治疗＋双水平正气道压力通气（BiPAP）观察组,分别于入选后2、24、72h、7d观察生命体征、测定肺功能、监测血气分析和氧饱和度,进行呼吸困难分级和辅助呼吸肌评分,从而比较两组患者的气体交换情况、住院时间、病死率及气管插管率等指标的差异.结果入组后2、24、72h、7d观察组较对照组PaCO2明显降低.观察组总的气管插管率明显降低（P＜0.05）,住院时间明显缩短（P＜0.01）.其中,当PaCO2≥65mmHg时两组患者插管率无明显差异（P＞0.05）,而PaCO2＜65mmHg时观察组较对照组插管率明显下降（P=0.04）.结论 COPD急性加重期早期应用BiPAP可明显增加患者的气体交换,改善患者的预后,提高患者的生活质量.

Study of the early use of noninvasive positive-pressive ventilationin acute exacerbations of COPD

Objective: To estimate the early use of noninvasive positive-pressure ventilation (NIPPV) in acute exacerbations of COPD.Methods: 90 COPD cases with hypercapnia were involved in the study.The patients were randomized into two groups (BiPAP and standard-therapy group).Standard-therapy group was control group.All the cases were recorded blood gas analysis at beginning and in 2, 24, 48, 72 and 7d respectively.Results: The groups had similar clinical characteristics and gas exchange at the beginning of trial.PaCO_2 was significantly decreased in BiPAP group in the trial.Compared with standard-therapy group, BiPAP also lowered the rate of endotracheal intubation (P<0.05) and the lenth of hospital stay (P<0.01).There is no difference in hospital mortality.Conclusion: The early application of NIPPV (BiPAP) to standard medical therapy does improve blood gas outcome in patients who develop hypercapnia and lower the rate of endotracheal intubation and the lenth of hospital stay.