无创正压通气治疗慢性阻塞性肺疾病并发肺性脑病撤机时间分析

目的 分析无创正压通气治疗慢性阻塞性肺疾病(COPD)并发肺性脑病(PEP)的最佳撤机时机.方法 回顾性分析2014年1月至2016年12月铜陵市人民医院呼吸内科收治的88例进行无创正压通气治疗的COPD并发PEP患者的临床资料,所有患者均在COPD并发PEP的诱发因素去除后及患者临床症状缓解时进行撤机,根据撤机时的二氧化碳分压(PaCO2)将患者分为对照组15例(PaCO2＜ 50 mmHg)与观察组73例(PaCO2≥50 mmHg);比较两组患者无创正压通气治疗时间及3个月内再次因PEP住院的复发率.结果 观察组无创正压通气治疗时间为(9.41 ±3.64)d,对照组无创正压通气治疗时间为(12.53 ±7.09)d,两组差异有统计学意义(P＜0.05).观察组3个月内复发率9.6％,对照组复发率6.7％,两组差异无统计学意义(P＞0.05).结论 无创正压通气治疗在COPD并发PEP的诱发因素去除后,患者临床症状缓解,无须等到PaCO2低于50 mmHg即可考虑撤机.

Analysis of time weaning from NIPPV in treatment of COPD with pulmonary encephalopathy

Objective To analyze the optimal time weaning from noninvasive positive pressure ventilation (NIPPV) in the treatment of those patients with chronic obstructive pulmonary disease (COPD) and pulmonary encephalopathy (PEP).Methods The clinical data of 88 patients with COPD and PEP,underwent NIPPV treatment in our hospital from Jan 2014 to Dec 2016,were retrospectively analyzed.All patients weaned from mechanical ventilation when inducing factors of COPD complicated with PEP were removed and their clinical symptoms were relieved.The patients were divided into the control group (PaCO2 ＜ 50 mmHg) of 15 cases and the study group (PaCO2 ≥ 50 mmHg) of 73 cases,according to their PaCO2 values at the time of weaning,and the treatment time of NIPPV and readmission rates because of PEP within 3 months between the two groups were compared.Results The treatment time of NIPPV in the two groups were (9.41 ± 3.64) d and (12.53 ±7.09) d,respectively,and the difference between them was statistically significant (P ＜ 0.05).The recurrence rate within 3 months was 9.60％ in the study group and 6.70％ in the control group,with no significant difference (P ＞ 0.05).Conclusion When the inducing factors of COPD complicated with PEP are removed,patients might wean from NIPPV treatment after relief of their clinical symptoms,regardless of the PaCO2 value less than 50 mmHg.