无创正压通气治疗copd合并ⅱ型呼吸衰竭伴右心衰竭临床研究

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1、无创正压通气治疗COPD合并Ⅱ型呼吸衰竭伴右心衰竭临床研究【摘要】目的探讨无创正压通气(NPPV)对慢性阻塞性肺病(COPD)合并Ⅱ型呼吸衰竭伴右心衰竭的治疗作用。方法选择COPD合并Ⅱ型呼吸衰竭伴右心衰竭57例，随机分为常规治疗组(27例)与常规治疗辅助NIPPV治疗组(30例)，观察患者的心率、呼吸频率、血气分析指标及血浆NT�Pro�BNP水平。结果治疗后两组心率、呼吸频率呈下降趋势、血气分析指标呈好转趋势，NT�Pro�BNP水平呈下降趋势。结论NIPPV可改善COPD合并Ⅱ型呼吸衰竭伴右心衰竭患者的酸中毒、增加氧合指数、减少PaCO�2；NT�Pr

2、o�BNP在呼衰并右心衰竭患者的诊断及疗效评价尚待进一步研究。�【关键词】COPD；Ⅱ型呼吸衰竭；右心衰竭；NIPPV��EffectofnoninvasivepositivepressureventilationinthetreatmentofpatientswithCOPDandpulmonaryheartdiseaseandtypeⅡrespiratoryfailureTUErXunGuliBurhan,DUXiang�lin,LIU6Zhan�hong,etal.DepartmentofPneumology,FriendshipHospitalofU

3、rumqiCity,Urumqi830049,China�【Abstract】ObjectiveTodetecttheeffectofnoninvasivepositivepressureventilation(NIPPV)inthetreatmentofpatientswithCOPDandpulmonaryheartdiseaseandtypeⅡrespiratoryfailure.MethodsFifty�sevenpatientswithCOPDandpulmonaryheartdiseaseandtypeⅡrespiratoryfailurewer

4、eenrolledinthestudy.Thepatientsweredividedrandomlyintoroutinetherapygroup(n=27)andtheNIPPVgroup(n=30).ThepatientsinroutinetherapygroupweretreatedwithroutinetherapyonlyandthoseinexperimentgroupweretreatedwithbothroutinetherapyandNIPPVbyBilevelpositiveairwaypressure(BiPAP)mode.Ineach

5、group,parametersofgasexchange,heartrateandrespiratoryrateandNT�Pro�BNPweremeasured.ResultsTheeffectoftheNIPPVgroupwasslightbetterthanthatofroutinetherapygroup.Theheartrateandrespiratoryrate6wereupandgasexchangewereshowedongoodtrackintheNIPPVgroup.ConclusionNIPPVcanimproveseveralphy

6、siologicalparametersofpatientswithCOPDandpulmonaryheartdiseaseandtypeⅡrespiratoryfailureinreducingacidpoisoning,increasinghematopneicindexandreducingPaCO�2.ItneedtoexploreifNT�Pro�BNPcanbeuseofdiseasediagnosisandcureeffectevaluationinthepeopleofCOPDandpulmonaryheartdiseaseandtypeⅡr

7、espiratoryfailure.�【Keywords】COPD;TypeⅡrespiratoryfailure;Pulmonaryheartdisease；NIPPV�作者单位：830049新疆乌鲁木齐市友谊医院呼吸科慢性阻塞性肺病(COPD)持续发展常可引起通气功能障碍加重,导致PaCO�2上升,PaO�2下降，出现Ⅱ型呼吸衰竭,严重时出现肺性脑病,甚至左、右心力衰竭。长期以来,6随着对有创通气所带来严重副作用的认识，无创正压通气(NIPPV)因无需气管插管或气管切开已被越来越多地用于COPD急性加重合并呼吸衰竭的治疗。本次研究探讨常规治疗同时辅助无创

8、正压通气治疗COPD合并Ⅱ型呼吸衰竭伴肺心病(右心衰