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目的研究无创正压通气(NIPPV)治疗老年慢性阻塞性肺病(COPD)急性加重期严重呼吸衰竭的效果。方法对30例老年COPD急性加重期严重Ⅱ型呼吸衰竭(均符合有创通气指征)患者,在常规治疗的基础上给予NIP-PV治疗,并监测生命体征、血气分析等指标,基础疾病采用急性生理与慢性健康评分(APACHEⅡ评分),神志改变采用Glasaow昏迷评分(GCS评分)。结果NIPPV 2 h,患者的心率、呼吸频率、血气分析指标(pH、PaO2、PaCO2)明显改善;NIPPV 24 h上述指标进一步改善(P<0.01),APACHEⅡ评分下降,GCS评分升高,以上与治疗前比较,差异均有统计学意义(P<0.05或<0.01)。治疗有效率86.7%,失败率13.3%。结论NIPPV治疗COPD急性加重期严重Ⅱ型呼吸衰竭患者效果较好。
Objective To investigate the efficacy of noninvasive positive pressure ventilation (NIPPV) in the treatment of severe respiratory failure in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Thirty elderly patients with severe exacerbation of COPD (all eligible for invasive ventilation) were enrolled in this study. NIP-PV was given on the basis of routine treatment and vital signs and blood gas analysis were monitored. Acute Physiology and Chronic Health Score (APACHE II score), conscious changes using Glasaow coma score (GCS score). Results The heart rate, respiratory rate and blood gas analysis index (pH, PaO2, PaCO2) of patients with NIPPV were significantly improved after 2 hours of NIPPV. The above indexes were further improved at 24 hours after NIPPV (P <0.01), the scores of APACHEⅡ decreased and the scores of GCS increased. Before comparison, the differences were statistically significant (P <0.05 or <0.01). Treatment efficiency of 86.7%, the failure rate of 13.3%. Conclusion NIPPV is effective in treating patients with severe type Ⅱ respiratory failure during acute exacerbation of COPD.