无创正压通气治疗慢阻肺昏迷患者的可行性及疗效预测研究

目的评估无创通气(NPPV)治疗慢性阻塞性肺疾病(慢阻肺)昏迷患者的可行性。探讨临床肺部感染评分(CPIS)的疗效预测性。方法将入选患者随机分为通气组(n=24例)及对照组(n=14例)。观察两组患者治疗前后血气、心率(HR)、呼吸频率(RR)变化。计算CPIS值,观察不同CPIS值,患者血气变化情况。结果两组患者治疗前,上述各指标无统计学差异,通气组治疗后PH、Pa CO2、HR、RR均有改善(P0.05)。对照组患者除PH外,余指标均未改善(P0.05)。治疗1天及结束时通气组Pa CO2、HR、RR低于对照组(P0.05),PH高于对照组(P0.01)。CPIS6通气组患者Pa CO2及PH改善有非常显著性意义(P0.01)。结论无创通气治疗慢阻肺昏迷患者具有一定的可行性,且CPIS评分对疗效有一定预测性。

Feasibility of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease complicated with coma and forecasting study of curative effect

Objective To evaluate the feasibility of noninvasive positive pressure ventilation(NPPV)in pa-tients with chronic obstructive pulmonary disease complicated with coma, and to investigate the forecasting study of clinical pulmonary infection score(CPIS)on curative effect. Methods The patients were divided into two groups randomly:the ventilation group(24 cases)and the control group(14 cases). Arterial gas analysis, heart rate(HR), and respiratory rate(RR)were observed before and after the treatment. The CPIS was calculated, and the changes of arterial blood gas analysis in the patients with different CPIS were observed. Results There was no signif-icant statistical difference in the above mentioned indexes before treatment. The value of pH, PaCO2 , HR and RR improved obviously after treatment in the ventilation group(P<0. 05). Except pH, other indexes were all not im-proved(P>0. 05). Compared with the control group, PaCO2, HR and RR of the ventilation group were lower(P<0. 05), and pH was higher(P<0. 01)at 1 day after treatment and the end. In the ventilation group, pH and PaCO2 were improved significantly in the patients with CPIS<6(P<0. 01). Conclusion There is a certain degree of the feasibility of NPPV in COPD patients with coma, and CPIS can play a certain role in forecasting prognosis.