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目的观察无创正压通气(NIPPV)在慢性阻塞性肺疾病急性加重(AECOPD)并Ⅱ型呼吸衰竭患者的临床疗效。方法选取2011年2月—2013年8月该院呼吸科收治的58例慢性阻塞性肺疾病急性加重并Ⅱ型呼吸衰竭患者应用BPAP呼吸机,分别记录治疗前后不同时段血气分析、呼吸频率、心率等变化,并分为成功组和失败组。结果 58例合并Ⅱ型呼吸衰竭的慢性阻塞性肺疾病急性加重患者,经无创正压通气治疗7d后,44例(75.86%)意识好转,生命体征平稳,治疗成功;14例(24.14%)因多种因素治疗失败。成功组治疗2h、72h、7d后pH、PaCO2、PaO2、RR、HR与治疗前比较均明显改善,差异有统计学意义(P<0.05);失败组在治疗2h后各项指标与治疗前比较均有好转,差异有统计学意义(P<0.05),但72h后病情恶化。结论对慢性阻塞性肺疾病急性加重合并Ⅱ型呼衰患者,尤其pH位于7.25~7.35的患者,在常规治疗同时,使用无创呼吸机辅助呼吸治疗,可促进早期恢复健康,提高生活质量,降低病死率。但是无创通气并不能完全替代有创通气,治疗时应密切观察,一旦病情恶化及时转换为有创机械通气。
Objective To observe the clinical efficacy of noninvasive positive pressure ventilation (NIPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and type Ⅱ respiratory failure. Methods From February 2011 to August 2013, 58 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and type Ⅱ respiratory failure (BPAP) were enrolled in this hospital from January 2011 to August 2013. Blood gas analysis, respiratory rate, heart rate And other changes, and divided into the success group and the failure group. Results In 58 patients with acute exacerbation of chronic obstructive pulmonary disease with type Ⅱ respiratory failure, 44 cases (75.86%) got better consciousness after treatment with noninvasive positive pressure ventilation for 7 days, the vital signs were stable and the treatment was successful. Among 14 cases (24.14%), Treatment of many factors failed. The values of PaCO2, PaO2, RR and HR in the successful group at 2h, 72h and 7d after operation were significantly improved compared with those before treatment (P <0.05), and those in the failed group at 2h after treatment were significantly lower than those before treatment All improved, the difference was statistically significant (P <0.05), but the condition deteriorated after 72h. Conclusion In patients with acute exacerbation of chronic obstructive pulmonary disease and type Ⅱ respiratory failure, especially in patients with pH ranging from 7.25 to 7.35, non-invasive ventilator-assisted respiratory therapy can be used in routine treatment, which can promote early recovery of health, improve quality of life and reduce mortality rate. However, noninvasive ventilation can not completely replace invasive ventilation, the treatment should be closely observed, if the deterioration of the timely conversion to invasive mechanical ventilation.