无创正压通气在COPD急性加重期伴呼吸衰竭患者中的应用.doc

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1、无创正压通气在COPD急性加重期伴呼吸衰竭患者中的应用作者：杨艳娟,崔丽萍,张锦,郑西卫作者单位：宁夏医学院附属医院呼吸内科，银川750004【摘要】目的探讨无创正压通气(NIPPV)对慢性阻塞性肺疾病(COPD)急性加重期伴呼吸衰竭患者的影响。方法58例COPD急性加重期患者在接受常规治疗的基础上加用BiPAPVision呼吸机进行无创通气治疗，50例对照组仅采用常规治疗而未进行正压通气，比较两组患者在血气分析指标、气管插管率、治愈率及住院率等方面的差异。结果血气分析显示治疗组在无创正压通气治疗4h后较治疗前血气指标即有改善(PaO265.236.36vs51.754

2、.60;PaCO252.767.64vs66.048.27;pH值7.290.12vs7.240.11);而对照组上述指标改善不大。随着通气时间的延长(24h)，治疗组血气分析指标较治疗前改变更明显(PaO288.628.47vs51.754.60;PaCO246.554.28vs66.048.27;pH值7.370.09vs7.240.11);治疗组较对照组在气管插管率、病死率及住院日等方面均低于对照组;结论早期应用NIPPV能迅速改善COPD急性加重期患者的气体交换，缓解呼吸肌疲劳，减少气管插管率，缩短住院日。【关键词】慢性阻塞性肺疾病,呼吸衰竭,无创正压通气Abs

3、tract：ObjectiveToevaluatetheeffectoftheearlyuseofnoninvasivepositivepressureventilation(NIPPV)ongasexchange,rateofendotrachealintubationandin-hospitalmortalityinpatientswithacuteexacerbationofchronicobstructivepulmonarydisease(COPD)whohaverespiratoryfailture.MethodsTherewerefithy-eightpa

4、tientswithacuteexacerbationofCOPDwhoweretreatedwithbothstandardtherapyandNIPPV,whilefithypatientsascontrolledgrouptreatedbystandardtherapyonlyinthestudy.Thantoobservedgasexchange,rateofendotrachealintubationandin-hospitalmortalityinthetwogroups.ResultsThegeneralconditionsweresimilarinbot

5、hgroups.Comparedwiththecontrolledgroup,thegasexchangewerehighlyimprovedafter4hoursinthetherapeuticgroup(PaO265.236.36vs51.754.60;PaCO252.767.64vs66.048.27;pH7.290.12vs7.240.11),whiletherewerenosignificantimprovedinthecontrolledgroup.WiththetimeoftreatedwithNIPPVgotlonger(24h),thebetterim

6、provedwiththepatientsinpH,PaCO2andPaO2(PaO288.628.47vs51.754.60;PaCO246.554.28vs66.048.27;pH7.370.09vs7.240.11).Inthisgroup,theforegoingparameterswereimprovedcontinuouslyinthecourseofthetreatment,andtheyshowednodeterioration24hoursafterterminationofNIPPV.Therateofendotrachealintubation、t

7、hein-hospitalmortalityandthedaysofhospitalizationintherapeuticgroupweresignificantlylowerthanthatofinthecontrolledgroup.ConclusionEarlyuseofNIPPVcanimprovegasexchange,lessenrespiratorymusclefatigue,decreasetheneedforintubationandreducehospitaladmissionsinpatientswithacute