无创机械通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭合并肺大泡的疗效观察

目的观察无创正压通气（NIPPV）辅助治疗慢性阻塞性肺疾病急性加重期呼吸衰竭合并多发性肺大泡患者的临床疗效。方法选择呼吸监护病房住院的57例患者为研究对象,随机分为2组,治疗组30例,对照组27例,2组均进行一般治疗,同时治疗组给予无创通气治疗,吸气压（IPAP）自8~12 cmH2O开始,压力逐渐上升至16~20 cmH2O。呼气压（EPAP）自2~4 cmH2O开始,氧流量2~5 L/min维持氧饱和度（SaO2）〉90%,治疗后2h、24 h、2 d、5 d复查动脉血气,并观察治疗前后临床表现及动脉血气结果。结果治疗组治疗48 h后,pH从治疗前（7.31±0.12）改善至治疗后（7.36±0.17）,差异无统计学意义;动脉血二氧化碳分压（PaCO2）从治疗前（69.17±11.09）mmHg下降至治疗后（38.11±11.12）mmHg（P〈0.05）,动脉血氧分压（PaO2）从治疗前（50.08±12.12）mmHg上升到（70.11±14.15）mmHg,差异有统计学意义;对照组PaO2、PaCO2也较治疗前好转,差异有统计学意义（P〈0.05）。治疗组有28例患者治疗后临床症状改善,气促减轻,有效率为93.3%,对照组有效率为66.6%,差异有统计学意义（P〈0.05）。治疗组的气管插管率和平均住院天数均低于对照组,差异有统计学意义（P〈0.05）。结论无创机械通气对于慢性阻塞性肺疾病急性加重期呼吸衰竭合并肺大泡疗效肯定,只要采取合理的通气策略,不会出现气胸等并发症,值得临床应用。

Efficacy of noninvasive positive pressure ventilation in the patients with acute respiratory failure due to COPD complicated with multi-pneumatocele

Objective To evaluate the efficacy of noninvasive positive pressure ventilation（ NIPPV） in the treatment of acute respiratory failure due to COPD complicated with multi-pneumatocele. Methods Fifty-seven patients in RICU were enrolled in the study. They were divided into two groups,the treatment goup（ n = 30） and the control group（ n = 27）.The patients in the treatment group received NIPPV treatment. IPAP began from 8~ 12 cm H2 O to 16~ 20 cm H2 O,EPAP was 2~ 4 cmH2 O,with an oxygen flow of 2~ 5 L /min. The level of SaO2 maintained above 90%.The clinical symptoms and blood gas analysis were detected 2 h,24 h,2 d,5 d after the therapy. Results The clinical symptoms and blood gas analysis were improved after treatment. pH was changed from 7. 31±0. 12 to 7. 36±0. 17（ P〉0. 05）,PaCO2 was decreased from 69. 17± 11. 09 mmHg to 38. 11 ± 11. 12 mmHg（ P〈0. 05）,and PaO2 was increased from 50. 08 ± 12. 12 mmHg to70. 11±14. 15 mmHg（ P〉0. 05）. The efficiency rate was 93. 3% and 66. 6% in treatment group and control group respectively（ P〉0. 05）. The rate of endotracheal intubation and hospitalized days were lower in treatment group than those in control group（ P〉0. 05）,and there were no pneumothorax in both of the two groups. Conclusions NIPPV is an effective method for acute respiratory failure due to COPD complicated with multi-pneumatocele,which may help the patients prevent form pneumothorax.