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目的探讨无创正压机械通气(NIPPV)用于治疗慢性阻塞性肺病(COPD)合并呼吸衰竭的作用。方法选择40例COPD合并呼吸衰竭的患者,随机分为NIPPV组(NIPPV+常规综合治疗)和对照组(常规综合治疗)。观察动脉血气分析、呼吸频率、心率、血压、辅助呼吸肌动用评分,及住院时间、气管插管率、住院病死率等。结果NIPPV组治疗后3h呼吸频率、心率、辅助呼吸肌动用评分均明显优于对照组(P<0.05),PaO2较治疗前明显改善(P<0.01),氧合指数明显改善(P<0.05),PaCO2与治疗前及对照组治疗后3h比较,亦有明显下降(P<0.05),NIPPV组较对照组住院时间缩短,气管插管率及病死率降低。结论无创正压通气具有无创伤性、可早期使用、并发症少、易被患者接受和使用方便等特点,可以迅速缓解呼吸困难、改善呼吸肌疲劳,提高PaO2、氧合指数,降低PaCO2,缩短住院时间,降低气管插管率和病死率,对于COPD合并呼吸衰竭是一种切实有效的治疗措施。
Objective To investigate the effect of non-invasive positive pressure mechanical ventilation (NIPPV) on chronic obstructive pulmonary disease (COPD) with respiratory failure. Methods Forty patients with COPD and respiratory failure were randomly divided into NIPPV group (NIPPV + conventional combined therapy) and control group (conventional combined therapy). Arterial blood gas analysis, respiratory rate, heart rate, blood pressure, assist breathing muscle activity score, hospital stay, tracheal intubation rate and in-hospital mortality were observed. Results The scores of respiratory rate, heart rate and auxiliary respiratory muscle function in NIPPV group were significantly better than those in control group at 3h after treatment (P <0.05), PaO2 was significantly improved (P <0.01) and oxygenation index was significantly improved (P <0.05) , PaCO2 was also significantly decreased compared with 3h after treatment (P <0.05). Compared with the control group, the hospitalization time of PaCO2 group was shorter and intubation rate and mortality rate of trachea decreased. Conclusion Noninvasive positive pressure ventilation is noninvasive and can be used early with few complications. It is easy to be accepted and used by patients. It can quickly relieve dyspnea, improve respiratory muscle fatigue, increase PaO2, oxygenation index, reduce PaCO2, and shorten Hospitalization, reduce tracheal intubation and mortality, COPD with respiratory failure is a practical and effective treatment.