双水平气道正压通气联用呼吸兴奋剂治疗慢性阻塞性肺病急性加重期并发Ⅱ型呼吸衰竭临床分析  

作　　者：祁学成 陈延超 王梅 陈新岩 蒲新菊 黄晓婷 

机构地区：[1]宁夏银川长庆燕鸽湖医院呼吸内科,750006

出　　处：《当代医学》2008年第9期7-8,共2页Contemporary Medicine

摘　　要：目的评价鼻面罩无创双水平气道正压（BiPAP）通气联用呼吸兴奋剂治疗慢性阻塞性肺病（COPD）急性加重期并发Ⅱ型呼吸衰竭的疗效。方法将32例COPD急性加重期并发Ⅱ型呼吸衰竭患者作为治疗组，采用呼吸兴奋剂、鼻面罩无创双水平气道正压（BiPAP）通气及常规治疗；观察患者血气指标变化（PH值、PaO2，PaCO2）及比较插管率。并同以往使用呼吸兴奋剂治疗的30例COPD急性加重期并发Ⅱ型呼吸衰竭的相似病例作为对照组进行比较分析。结果治疗组32例患者中28例治疗成功，另外4例病情加重需要气管插管机械通气治疗；对照组30例患者中16例治疗成功，14例需气管插管机械通气治疗。治疗组气管插管率明显低于对照组（P〈0.05）。治疗组治疗前pH7．25±0．05、PaCO2为（83±12）mmHg（1mmHg=0.133kPa）、PaO2为（53.9±6.3）mmHg，在平均治疗5d后PH为7．32±0．08（P〈0．01）、PaCO2为（61±9）mmHg（P〈0.05），PaO2为（84±15）mmHg（P〈0.05）。结论双水平气道正压通气联用呼吸兴奋剂治疗慢性阻塞性肺病急性加重期并发Ⅱ型呼吸衰竭患者疗效确切，明显降低插管率。Objective To determine the efficacy of Nasal mask Nononvasive Bi-level positive airway pressure ventilation plus respiratory stimulants With patients who suffered from acute exacerbations of chronic obstructive pulmonary disease （COPD） with type II respiratory failure. Methods 32 patients who suffered from acute exacerbations of chronic obstructive pulmonary disease （COPD） with type II respiratory failure in treatment group, with Nononvasive bi-level positive airway pressure ventilation plus respiratory stimulants and the conventional treatment .Observe the data in arterial blood gas （pH, PaO2, PaCO2）, the rate of endotracheal intubation with Nononvasive bi-level positive airway pressure ventilation plus respiratory stimulantsand compare with 30 patients without respiratory stimulants treatment before.Results 28 of 32 cases were successfully in treatment group, other 4 cases need for endotracheal intubation due to an acute exacerbation of COPD; 16 of 30 cases were successfully in control group, other14 cases need for endotracheal intubation due to an acute exacerbation of COPD. the rate of endotracheal intubation of the patient was significantly lower in treatment group than in control group. Nononvasive bi-level positive airway pressure ventilation plus respiratory stimulants increased PaO2 significantly[（84±15） mmHg vs （53.9±6.3） mmHg]（P〈0.05） ,declined PaCO2 significantly[（83±12）mmHg vs （61±9） mmHg] （P〈0.05） ,elevated blood pH [（7.25±0.05） vs （7.32±0.08）] （P〈0.01） and 5 days after treats. Conclusion Nononvasive hi-level positive airway pressure ventilation plus respiratory stimulants is a effective therapy for the patients with acute exacerbations of chronic obstructive pulmonary disease （COPD） with type II respiratory failure .Its significantly dereased the need for endotracheal intubation.

关 键 词：无创双水平气道正压通气 呼吸兴奋剂 慢性阻塞性肺病 呼吸衰竭 

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