无创正压通气救治高龄重度呼吸性酸中毒患者的临床疗效评价

目的 探讨无创正压通气救治高龄重度呼吸性酸中毒患者的临床疗效.方法 选择2010年9月至2012年9月呼吸科救治的慢性阻塞性肺疾病急性加重伴重度呼吸性酸中毒的Ⅱ型呼吸衰竭患者56例为研究对象,分别予以常规基础治疗（对照组,n =28）和常规基础治疗＋无创正压通气治疗（实验组,n =28）,比较两种治疗方法的临床疗效.结果 两组治疗前pH值、PaO2及PaCO2相比差异均无统计学意义（P均＞0.05）,两组治疗后pH值、PaO2及PaCO2相比差异均有统计学意义（P均＜0.05）.实验组治疗后pH值、PaO2及PaCO2与治疗前相比均明显改善（P均＜0.05）.实验组有4例予以有创机械通气,插管率为14.29％,对照组11例予以有创机械通气,插管率为39.29％,两组治疗后插管率比较,差异具有统计学意义（P＜0.05）.结论 无创正压通气治疗慢性阻塞性肺疾病急性加重伴重度呼吸性酸中毒的Ⅱ型呼吸衰竭可改善患者的血气分析指标,降低治疗后的有创通气的病例数,从而改善患者的临床症状,减轻患者的经济负担.

Clinical efficacy evaluation of noninvasive positive pressure ventilation in the treatment of aged patients with severe respiratory acidosis

Objective To explore the clinical efficacy of noninvasive positive pressure ventilation （NIPPV） in the treatment of aged patients with severe respiratory acidosis. Method Fifty-six patients with type II respiratory failure duo to acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and complicated with severe respiratory acidosis admitted in our department from September 2010 to September 2012 were enrolled in this study. The 56 patients were randomly divided into two groups （ n = 28 each） ： experimental group and control group. The conventional basic therapies were given in control group, and NIPPV treatment on top of the conventional basic therapies were given in experimental group. The clinical efficacy of two groups was compared. Results There were no significant differences in pH, PaO2 and PaCO2 before treatment between the two groups （ all P 〉 0.05 ）. The improvements of pH, PaO2 and PaCO2 after treatment in experimental group were all more obvious than those in control group （ all P 〈 0.05 ）. Compared with before treatment, pH, PaO2 and PaCO2 4 h, 24 h after treatment in experimental group and 24 h after treatment in control group were significantly improved （ alt P 〈 0.05 ） , The NIPPV that need to be converted to invasive mechanical ventilation was seen in 4 cases for experimental group and in 11 cases for control group, and the intubation rate in experimental group was significantly lower than that in control group （ 14.29% vs 39.29% ,P 〈 0.05 ）. Conclusions NIPPV can obviously improve indexes of blood gas analysis for the treatment of AECOPD with type II respiratory failure complicated with severe respiratory acidosis and reduce the case number of mechanical ventilation, therefore improve the clinical symptoms and reduce the economic burden of the patients.