无创正压通气救治慢性阻塞性肺疾病并重度呼吸衰竭的临床探讨  

Clinical investigation of non-invasive positive pressure ventilation in treatment for patients with chronic obstructive pulmonary disease and severe respiratory failure

作　　者：向平超[1] 杨珺楠[1] 郭伟安[1] 鞠立新[1] 张硕[1] 朱卫京[1] 雷涛[1] 孙佳[1] 

机构地区：[1]北京大学首钢医院呼吸科,北京100041

出　　处：《中国呼吸与危重监护杂志》2006年第1期16-18,共3页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的评估无创正压通气（NIPPV）在救治慢性阻塞性肺疾病（COPD）急性加重期并重度呼吸衰竭伴有不同程度的神志障碍者中的价值，为更好地选择NIPPV的临床应用适应证提供指导。方法对入选的31例COPD急性加重期并重度呼吸衰竭伴有不同程度的神志障碍者使用双水平无创正压呼吸机面罩辅助通气，动态观察NIPPV治疗前和治疗后2h、8h、1d及3d动脉血气、神志、NIPPV治疗的压力调节最高值、治疗后病人的转归、NIPPV的不良反应及并发症。结果31例患者中，27例经NIPPV治疗3d后与治疗丽比较，PaO2明显升高[（95．45±22．00）mmHg比（54．17±12．26）mmHg，P〈0.01]，PaCO2明显降低[（65．05±9．00）mmHg比（87．54±14．82）mmHg，P〈0.01]，pH明显升高（7．36±0．04比7．25±0．06，P〈0．01），均脱机出院，有效率达87．09％（27／31）；4例改为有创通气，其中2例经有创与无创序贯机械通气治疗后脱机成功，1例死亡，1例自动出院。吸气压力〈20cm H2O 1例，20～25cnH2O25例，26～28cmH2O 5例；呼气压力为3～5cm H2O。结论双水平无创正压通气对有选择的COPD急性加重期并重度呼吸衰竭伴有不同程度的神志障碍者疗效确切，但应准确掌握无创呼吸机的操作方法，合理地调整各种参数，特别是吸气支持压力。Objective To evaluate the value of non-invasive positive pressure ventilation （NIPPV） in the treatment of chronic obstruetive pulmonary disease（COPD） with severe respiratory failure. Methods 31 patients with acute exacerbation of COPD and severe respiratory failure complicated with different degree of conscious disturbances were enrolled. Subjects received assisted ventilation via face mask by bi-level noninvasive positive ventilator.The change, of arterial blond gas, conscious state, the peak pressure of NIPPV, outcome anti complications of NIPPV were investigated. Results NIPPV increased PaO2 significantly [（ 95.45 ± 22.00）mm Hg vs（54.17 ± 12.26）mmHg]（ P〈 0.01 ）,declined PaCO2 significantly [（65.05 ± 9.00） mmHg vs （87.54 ± 14.82） mmHg （ P 〈 0.01 ）, elevated blood pH[ （ 7.36 ± 0.04） vs （ 7.25 ± 0.06, P 〈 0.01 ） ] in all but four subjects who switched to invasive ventilation. Twenty-seven patients recovered consciousness, weaned from the ventilator and discharged successfully. Of the patients who switched to invasive ventilation, 2 were switched to sequential non-invasive mechanical ventilation and discharged, one died of multiple organ failure, and one gave up the treatment. The inspiratory positive airway pressure（IPAP） of NIPPV was 〈 20 cm H2O in 1 case, 20- 25 cm H2O in 25 eases, and 26 - 28 cm H2O in 5 cases. The expiratory positive airway pressure（EPAP） was hetween 3 and 5 cm H2O. Conclusions Bi-level noninvasive positive ventilation is a effective therapy for the patients with acute exacerbation of COPD and severe respiratnry failure. The conscious disturbances is not the contraindication for NIPPV. However, it is esscntial to select the subjects seriously and adjust ventilation parameters reasonably.

关 键 词：无创正压通气 慢性阻塞性肺疾病 呼吸衰竭 

分 类 号：R563.9[医药卫生—呼吸系统]