无创正压通气改善慢性阻塞性肺疾病并呼吸衰竭的临床观察

目的评价无创正压通气(NPPV)治疗慢性阻塞性肺疾病(COPD)的临床效果.方法51例COPD急性加重并Ⅱ型呼吸衰竭患者随机分为常规治疗组(26例)和NPPV组(25例),观察两组患者治疗前后动脉血气变化及病情转归.结果与治疗前比较,NPPV组治疗24 h后PaO2明显升高,PaCO2明显下降(P＜0.01),常规治疗组治疗24 h后PaO2亦有上升(P＜0 05),PaCO2则无明显变化,(P＞0.05).治疗24 h后NPPV组PaO2升高和PaCO2下降较常规治疗组更为显著(P＜0.05).常规治疗组的失败率(34.6%)显著高于NPPV组(16.0%,P＜0.05).NPPV组的平均住院天数(14.5±6.7)d明显短于常规治疗组(23.8±9.2)d,P＜0.05.结论NPPV可明显改善COPD急性加重并Ⅱ型呼吸衰竭患者的气体交换,纠正低氧血症和高碳酸血症,提高抢救成功率.

Clinical Observations of NPPV Improving the gas Ventilation of Patients with COPD and Respiratory Failure

Objective: To evaluate the clinical effect of NPPV for respiratory failure in the patients with chronic obstructive pulmonary disease(COPD). Methods:Fifty one patients with COPD and type II respiratory failure were randomly divided into two groups: conventional therapy(CT) group and noninvasive positive pressure ventilation(NPPV) group. The arterial blood gases were observed before and after the treatment. Prognosis was analyzed in the two groups. Results:Compared with pre-treatment, the level of PaO 2 was apparently increased and the PaCO 2 decreased after 24 hour by NPPV (P<0.01). In CT group the level of PaO 2 was increased, PaO 2 was unchanged after treatment. The degree of increase or decrease has significant differences between the two groups (P<0.05). The failure rate of treatment in CT group(34.6%) was higher than the NPPV group(16.0%,P<0.05). The average hospitalization day of the NPPV group was significantly shorter than the CT group. Conclusion: NPPV can effectively improve the gas ventilation with correcting hypoxia and hypercapnia, and to increase the successful rescue rate in the patients with COPD and type II respiratory failure.