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

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BiPAP Vision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(PaO265.23±6.36 vs 51.75±4.60;PaCO252.76±7.64 vs 66.04±8.27;pH值7.29±0.12 vs 7.24±0.11);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(PaO288.62±8.47 vs 51.75±4.60;PaCO246.55±4.28 vs 66.04±8.27;pH值7.37±0.09 vs 7.24±0.11);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 　　Abstract：Objective To evaluate the effect of the early use of noninvasive positive pressure ventilation (NIPPV) on gas exchange, rate of endotracheal intubation and in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD)who have respiratory failture. Methods There were fithy-eight patients with acute exacerbation of COPD who were treated with both standard therapy and NIPPV, while fithy patients as controlled group treated by standard therapy only in the study. Than to observed gas exchange, rate of endotracheal intubation and in-hospital mortality in the two groups. Results The general conditions were similar in both groups. Compared with the controlled group, the gas exchange were highly improved after 4 hours in the therapeutic group(PaO2 65.23±6.36 vs 51.75±4.60;PaCO2 52.76±7.64 vs 66.04±8.27;pH7.29±0.12 vs 7.24±0.11),while there were no significant improved in the controlled group. With the time of treated with NIPPV got longer(24h),the better improved with the patients in pH, PaCO2 and PaO2(PaO2 88.62±8.47 vs 51.75±4.60;PaCO2 46.55±4.28 vs 66.04±8.27;pH 7.37±0.09 vs 7.24±0.11).In this group, the foregoing parameters were improved continuously in the course of the treatment, and they showed no deterioration 24 hours after termination of NIPPV. The rate of endotracheal intubation、the in-hosp