有创与无创通气治疗慢性阻塞性肺疾病所致重度呼吸衰竭的随机对照研究  

Invasive and non-invasive ventilation in treatment of severe respiratory failure of chronic obstructive pulmonary disease:a randomized controlled study

作　　者：龙威[1] 王逢强[1] 陆伟[1] 丁春梅[1] 张羽[1] 何伟[2] 

机构地区：[1]复旦大学附属上海市第五人民医院急诊科,上海200240 [2]复旦大学附属上海市第五人民医院呼吸科,上海200240

出　　处：《复旦学报（医学版）》2007年第2期288-291,共4页Fudan University Journal of Medical Sciences

摘　　要：目的比较有创与无创通气在慢性阻塞性肺疾病急性加重(AECOPD)所致重度呼吸衰竭治疗中的效果。方法我院EICU、RICU收治AECOPD合并重度呼吸衰竭患者52例入选本研究,随机分为面罩机械通气(FMMV)组25例和人工气道机械通气(ETMV)组27例,比较两组患者治疗前后的生理及临床指标。结果机械通气2h后,ETMV组的pH、PaCO2、PaO2、HR、RR、Kelly评分明显改善(P均<0.01),FMMV组仅PaO2、HR、RR出现明显改善(P<0.01,P<0.05,P<0.05),pH、PaCO2、Kelly评分在4h后才出现明显改善(P<0.05,P<0.01,P<0.01);FMMV组的气管插管率为44%;ETMV组的机械通气时间短于FMMV组(P<0.01);两组的住ICU时间、总住院时间、住院病死率没有明显差别(P均>0.05)。结论在治疗AECOPD并重度呼吸衰竭时,ETMV能更快地改善血气指标,逆转高碳酸血症性脑病,机械通气时间短于FMMV;FMMV可使部分患者避免气管插管;接受此两种方法治疗的患者在住ICU时间、总住院时间、住院病死率方面无明显差别。Purpose To compare the efficacies of invasive and non-invasive ventilation for severe respiratory failure in patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD）. Methods Fifty-two AECOPD patients with severe respiratory failure in EICU and RICU were enrolled and randomly divided into 2 groups：face mask mechanical ventilation（group FMMV, n = 25） and endotracheal intubation mechanical ventilation（group ETMV,n = 27）. Results After 2 hours of mechanical ventilation, pH, PaCO2, PaO2, HR, RR, Kelly score were significantly improved in group ETMV（P〈0. 01 ）, however, in group FMMV, only PaO2, HR, RR were significantly improved（P〈 0. 01 ,P〈0. 05 ,P〈0. 05） ,pH ,PaCO2 ,Kelly score were significantly improved after 4 h（P〈0. 05 ,P〈0. 01, P〈0. 01）. The rate for intubation was 44% in group FMMV; the duration of mechanical ventilation was shorter in group ETMV（P〈0. 01） ;There was no significant difference in the days in ICU, days in hospital and mortality in hospital between these two groups（P〉0.05）. Conclusions ETMV can improve the arterial blood gas of severe respiratory failure of AECOPD quickly,reverse hypercapnic encephalopathy and shorten the duration of mechanical ventilation; some patients can avoid the need of intubation through FMMV;as for the days in ICU, days in hospital and mortality in hospital, there is no significant difference between ETMV and FMMV.

关 键 词：慢性阻塞性肺疾病 高碳酸血症性脑病 面罩机械通气 人工气道机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]