无创正压通气治疗COPD急性加重导致高碳酸血症的临床研究

目的对比无创正压通气（NPPV）对慢性阻塞性肺疾病（COPD）急性加重导致轻中度高碳酸血症与重度高碳酸血症的疗效。方法对比入选COPD急性加重导致轻中度高碳酸血症（PaCO2〈80mmHg,1mmHg=0.133kPa）组患者和重度高碳酸血症（PaCO2〉80mmHg）组患者NPPV2h后pH值和PaCO2的变化、24h后pH值恢复正常的人数、总的NPPV治疗时间和住院天数。结果轻中度高碳酸血症组44人,重度高碳酸血症组42人。轻中度高碳酸血症组和重度高碳酸血症组相对比,NPPV2h后pH值（分别为0.04±0.01和0.06±0.03,P=0.63）和PaCO2分别为（14.3±7.4）mmHg和（18.1±11.2）mmHg,P=0.34]的改善程度相似。对比两组患者NPPV24h后pH值恢复正常比率（分别为65.9%和59.5%,P=0.65）、NPPV应用时间分别为（103±8.1）h和（106±6.6）h,P=0.74]、住院天数分别为（13±2.7）d和（15±4.1）d,P=0.53]及NPPV失败率（分别为13.6%和19.0%,P=0.56）也无差异。结论 NPPV治疗对COPD急性加重导致重度高碳酸血症的患者是有效的。

Clinical research on noninvasive positive-pressure ventilation in treating hypercapnemia caused by acute exacerbations of chronic obstructive pulmonary disease

Objective To compare the curative effects between mild-moderate hypercapnia and severe hypercapnia caused by acute exacerbations of chronic obstructive pulmonary disease treated with noninvasive positive pressure ventilation （NPPV）.Methods Patients with mild-moderate hypercapnia（PaCO280 mmHg,1 mmHg=0.133 kPa）and severe hypercapnia（PaCO280 mmHg）caused by acute exacerbations of chronic obstructive pulmonary disease were enrolled.The pH value and PaCO2 2 h after NPPV,number of patients with normal pH value 24 h after NPPV,treatment time and hospital day were observed.Results Forty four patients with mild-moderate hypercapnia and forty two severe hypercapnia.There were no significant difference of the pH value（0.04±0.01 vs 0.06±0.03,P=0.63） and PaCO2（14.3±7.4 vs 18.1±11.2 mmHg,P=0.34）2 h after NPPV,proportion of patients with normal pH value（65.9% vs 59.5% respectively,P=0.65）24 h after NPPV,treatment time（103±8.1 vs 106±6.6 h,P=0.74）and hospital day（13±2.7 vs 15±4.1 days,P=0.53）between the two groups.Conclusion NPPV is effective in the treatment of severe hypercapnia caused by acute exacerbations of COPD.