慢性阻塞性肺疾病急性加重期患者应用无创性正压通气难以纠正的原因分析  

Analysis of the reasons in the treatment failure with noninvasive positive pressure ventilation for some patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：张舒[1] 张琪琳[1] 

机构地区：[1]上海市第七人民医院呼吸内科,200137

出　　处：《北京医学》2008年第12期725-728,共4页Beijing Medical Journal

摘　　要：目的分析慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)患者使用无创性正压通气(NIPPV)治疗难以纠正的原因所在。方法回顾我院4年来应用NIPPV治疗AECOPD243例患者的资料,其中男169例,女74例。依据治疗前后临床症状、体征和动脉血气分析,分为有效组(206例)和无效组(37例)。对两组患者治疗前一般情况、用机情况以及NIPPV无效者进一步治疗情况进行分析。结果两组比较患者的意识情况、第一秒用力呼气容积(FEV1)减退的严重程度及痰液黏稠、引流不畅有显著性差异(P﹤0.05)。两组患者呼吸机连接方式、是否存在面罩漏气及呼吸机参数调节亦有显著性差异(P﹤0.05)。NIPPV无效组通过更换鼻罩、调整呼吸机压力、延长无创通气时间及纠正低血压、电解质紊乱等,19例患者仍通过无创通气治疗而得到好转。结论NIPPV原则上可适用于治疗各种情况的COPD合并呼吸衰竭的患者,但排痰能力严重减弱、呼吸道分泌物潴留、意识障碍以及有严重精神症状的患者,应慎重选用无创通气治疗。同时在使用无创通气的过程中应根据动脉血气情况及时调整连接方式和通气参数。Objective To analyze the reasons in the treatment failure with nominvasive positive pressure ventilation（NIPPV） for patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods 243 cases with AECOPD admitted in our hospital in the recent four years, who were treated with NIPPV, were investigated retrospectively. Patients were divided into NIPPV ineffective group and NIPPV effective group according to the changing of the clinical symptom, physical sign and PaO2 before and after treatment. The pretreatment condition of the patients, the usage of the rentilator and the results of the further treatment in NIPPV failure group were analyzed. Results There were statistically significant differences in the patients＇ consciousness, degree of the FEV1 and the difficulty in expectoration of mueopurnlent sputum befween NIPPV ineffective and effective group （P 〈 0.05）. Significant differences（P 〈 0.05） were also found in the connecting pattern of the ventilator, the existing of mask leakage and ventilator parameter adjustment between two groups. Some patients in NIPPV ineffective group were improved after the corresponding intervention with the posive pressure vontilation. Conclusions Although NIPPV is applicable to the different situations of the COPD patients with respiratory failure, it should be cautious for the use of NIPPV in the patients with the severe difficulty in expectoration of mucopurnlent sputum, consciousness disturbance, and COPD pstients with psychopathic systoms. During the course of NIPPV usage, the conneting pattern and parameter of the ventilator should be adjusted according to the PaO2 of the the patients.

关 键 词：慢性阻塞性肺疾病急性加重期 无创性正压通气 呼吸衰竭 

分 类 号：R563.9[医药卫生—呼吸系统]