无创呼吸机在COPD急性发作早期治疗和延迟治疗的对比研究

目的探讨无创呼吸机早期治疗和延迟治疗在慢性阻塞性肺疾病(COPD)急性发作早期治疗中的临床价值。方法 COPD急性发作期的患者,根据给予无创呼吸机辅助治疗时间分为两组,分别为延迟治疗组40例,早期治疗组43例。延迟治疗组采用给氧、抗感染、抗炎、解痉、平喘及祛痰等常规治疗,经过一段时间常规治疗后未缓解者,给予无创呼吸机治辅助呼吸,其中有部分病患者需要行插管或气管切开后给予呼吸机治疗。早期治疗组在常规治疗组的基础上同时早期给予无创呼吸机辅助治疗。经治疗后3 h观察患者呼吸困难及神智情况、心率(HR)、呼吸频率(RR)、平均动脉压(MBP)等;机械通气前后动脉血氧分压(PaO2)和二氧化碳分压(PaCO2)。观察两组患者的病情好转率、住院时间及气管插管率,并进行统计学分析。结果与延迟治疗组比较,早期采用呼吸机治疗的患者心率、呼吸次数、平均动脉压、PaO2、PaCO2改善明显,且差异有显著性(P均<0.05)。早期治疗组患者较延迟治疗组相比较病情好转率高,住院时间缩短;气管插管率降低。结论早期应用无创呼吸机治疗COPD急性发作患者能迅速改善患者症状和低氧血症,提高病情好转率,减少气管插管,是一种快速安全有效地抢救措施。

The comparative study of early intervention and delayed using the non-invasive ventilation in patients with acute exacerbation of COPD

Objective To analyze the clinical effects of early intervention and delayed using the non-invasive ventilation in patients with acute COPD exacerbation.Methods According to the time of giving non-invasive ventilation,all patients with acute COPD exacerbation were divided into the early intervention treatment group（43 cases） and delayed treatment group（40 cases）.The delayed treatment group received conventional treatment including administration of oxygen,anti-infection,anti-inflammation,relieve spasm,antiasthmatic and expectorant treatment;after a period of time of treatment,the patients who did not alleviate were given ventilator therapy and some of them required intubation.On the basis of conventional treatment,the early intervention treatment group received non-invasive ventilation therapy early.Breathing difficulties and intoxicated condition,heart rate（HR）,respiratory rate（RR） and mean arterial pressure（MBP） were observed after treating 3 hours.Arterial oxygen partial pressure（PaO2） and partial pressure of carbon dioxide（PaCO2） results were obtained before and after mechanical ventilation.At the same time,the improvement rate,hospitalization time and endotracheal intubation rate were observed.The data of the patients before and after therapy were compared.Results Compared with conventional treatment group,HR,RR,MBP,tidal volume,PaO2 and sign improved more obviously in early intervention treatment group（all P〈0.05）.In addition,higher improvement rate,shorter hospital time and lower endotracheal intubation rate were observed in early intervention treatment group.Conclusion Early application of noninvasive ventilation treatment may rapidly improve the patients＇ symptoms and hypoxemia,decrease the need for endotracheal intubation in patients with acute exacerbation COPD.And it is a fast,safe and effective rescue measure.