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目的观察面罩双水平无创正压通气(BiPAP)对煤工尘肺(CWP)并发Ⅱ型呼吸衰竭的治疗作用。方法将56例CWP并发Ⅱ型呼吸衰竭的患者分成治疗组(32例)和对照组(24例),比较两组患者治疗前、后血气分析指标及临床症状的改善情况。结果治疗3d后,治疗组全部CWP患者呼吸频率和心率下降、气急缓解、辅助呼吸肌动作减弱率达100%,而对照组这4项指标的改善率仅为33%,差异有统计学意义(P<0.01);治疗组PaO2[(9.0±0.5)kPa]升高、PaCO2[(6.5±1.5)kPa]降低、SaO2(93.2%±3.2%)升高的幅度均较对照组[(8.6±2.9)kPa、(8.1±1.0)kPa、85.2%±2.4%]大,差异亦有统计学意义(P<0.05或P<0.01)。结论面罩BiPAP治疗CWP并发Ⅱ型呼吸衰竭依从性强,可解除呼吸肌疲劳,纠正呼吸衰竭,提高生存率,疗效肯定。
Objective To observe the therapeutic effect of bi-level mask noninvasive positive pressure ventilation (BiPAP) on type Ⅱ pneumoconiosis complicated with coal worker’s pneumoconiosis (CWP). Methods Fifty-six patients with CWP complicated with type Ⅱ respiratory failure were divided into treatment group (32 cases) and control group (24 cases). The improvement of blood gas analysis indexes and clinical symptoms were compared between the two groups before and after treatment. Results After 3 days of treatment, the respiratory rate and heart rate of all CWP patients in the treatment group were decreased, their acute gas shortness was alleviated, and the weakening rate of the auxiliary respiratory muscles was 100%. The improvement rate of the 4 indexes in the control group was only 33%, with significant difference P <0.01). PaO2 [(9.0 ± 0.5) kPa], PaCO2 [(6.5 ± 1.5) kPa] and SaO2 (93.2% ± 3.2% 2.9) kPa, (8.1 ± 1.0) kPa, 85.2% ± 2.4%]. The difference was also statistically significant (P <0.05 or P <0.01). Conclusion The mask BiPAP has strong compliance with CWP complicated with type Ⅱ respiratory failure, which can relieve respiratory muscle fatigue, correct respiratory failure and improve survival rate.