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目的:观察BiPAP呼吸机治疗COPD伴Ⅱ型呼吸衰竭的疗效及通气前后血清甲状腺激素的变化及其意义。方法:32例COPD合并Ⅱ型呼吸衰竭的患者,经常规治疗无效,给予BiPAP呼吸机通气治疗,应用放免法测定患者通气前后血清三碘甲状腺原氨酸(T_3)、甲状腺素(T_4)、反三碘甲状腺原氨酸(rT_3)及促甲状腺素(TSH),并与27例正常对照组进行了比较。结果:BiPAP持续通气72小时后,患者潮气量增加(P<0.01),动脉血PaO_2明显上升,Pa0_2显著下降(P均<0.01)。通气前患者血清T_3低于rT_3明显高于正常对照组(P<0.05,P<0.01);撤机前T_3较通气前明显升高,rT_3降低(P<0.05,P<0.01);25例撤机成功者T_3明显升高/rT_3明显低于5例撤机失败者(P均<0.01)。结论:Bi-PAP呼吸机对COPD并发Ⅱ型呼衰的疗效肯定,随着缺氧的改善,患者异常的甲状腺激素得以纠正,同时提示测定血清T_3和rT_3可预测机械通气患者撤机的成败。
Objective: To observe the curative effect of BiPAP ventilator in treating COPD with type Ⅱ respiratory failure and the changes of serum thyroid hormone before and after ventilation. Methods: Thirty two patients with COPD and type Ⅱ respiratory failure were treated with BiPAP ventilator ventilation after routine therapy. Serum triiodothyronine (T_3) and thyroxine (T_4) before and after ventilation were measured by radioimmunoassay. Triiodothyronine (rT_3) and thyrotropin (TSH), and compared with 27 normal control group. Results: After 72 hours of continuous ventilation of BiPAP, tidal volume of patients increased (P <0.01), PaO_2 of arterial blood increased significantly and Pa0_2 decreased significantly (all P <0.01). The level of serum T_3 in patients before ventilation was significantly lower than that in patients with normal controls (P <0.05, P <0.01); T_3 before weaning was significantly higher than that before ventilation and rT_3 was decreased (P <0.05, P <0.01) The success rate of T_3 was significantly higher / rT_3 was significantly lower than those of 5 patients with weaning failure (all P <0.01). Conclusions: Bi-PAP ventilator is effective in COPD with type Ⅱ respiratory failure. With the improvement of hypoxia, the abnormal thyroid hormone can be corrected. At the same time, the determination of serum T_3 and rT_3 can predict the success or failure of ventilator in patients with mechanical ventilation.