COPD急性加重期呼吸衰竭伴意识障碍患者的无创通气研究?  

The Research of Using Non-invasive Positive Pressure Ventilation in Patients with Respiratory Failure in Acute Exacerbations of COPD with Consciousness Disturbance

作　　者：古利明[1] 张继华[1] 潘琼兰[1] 李安稳[1] 张毅[1] 高明[1] 周云春[1] 

机构地区：[1]云南玉溪市人民医院呼吸内科,玉溪653100

出　　处：《中国医药导刊》2008年第2期178-181,共4页Chinese Journal of Medicinal Guide

摘　　要：目的:研究无创正压通气(NIPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)呼吸衰竭伴意识障碍患者的疗效。方法:16例慢性阻塞性肺疾病急性加重期呼吸衰竭伴意识障碍行无创正压通气(NIPPV),并与同期14例慢性阻塞性肺疾病急性加重期呼吸衰竭无意识障碍患者比较。结果:慢性阻塞性肺疾病急性加重期呼吸衰竭伴意识障碍患者通气2～4小时后,pH由(7.16±0.08)升至(7.28±0.05),PCO_2由(111±20)降至(91±21),而且多数病人意识转清,两组治疗有效率分别为81%和86%(12/14),A组略低于B组,但两组差异无显著性(P>0.05)(12/16)。结论:意识障碍不应是无创正压通气(NIPPV)的禁忌症,加强意识障碍患者清醒前呼吸道分泌物吸引及胃胀气的引流,合理选用机械同气模式和参数是治疗成功的关键。Objective： To evaluate the effect of non-invasive positive pressure ventilation （NIPPV） in patients with respiratory failure, in acute exacerbations of COPD with consciousness disturbance. Methods： 16 cases treated by NIPPV in patients with respiratory failure in acute exacerbations of COPD with consciousness disturbance, compare to another 13 cases in the same pathological condition without treating by NIPPV. Results： After the 2 -4 hours ventilation to patients with respiratory failure in acute exacerbations of COPD with consciousness disturbance, patients＇ blood pH rise from（ 7. 16 ±0.08 ）to（ 7.28 ± 0. 05 ）, PCO2 fall from（ 111±20） to（91 ±21 ）. most of patients become awake. The efficacy of both group are 81% and 86% （ 12/ 14 ） respectively, group A is slight lower than B, but there are no significant differences. Conclusion： Consciousness disturbance is not contraindication of treatment with NIPPV. The keys to using NIPPV in patients with respiratory failure in acute exacerbations of COPD with consciousness disturbance are drainage of respiratory tract secretion and gastric distension, reasonable model and parameters of mechanical ventilation.

关 键 词：呼吸衰竭 慢性阻塞性肺疾病 无倒正压通气 意识障碍 

分 类 号：R563.9[医药卫生—呼吸系统] R563.8[医药卫生—内科学]