无创机械通气治疗COPD合并Ⅱ型呼吸衰竭疗效观察  

Effectiveness of BiLevel Positive Airway Pressure Ventilation in COPD Complicated with Type Ⅱ Respiratory Failure

作　　者：沈进[1] 傅静奕[2] 

机构地区：[1]四川省乐山市红十字会医院,四川乐山614000 [2]中山大学附属第三医院,广东广州510630

出　　处：《华西医学》2009年第1期61-63,共3页West China Medical Journal

摘　　要：目的：探讨双水平气道正压无创通气（BiPAP）对慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease，COPD）合并Ⅱ型呼吸衰竭的治疗价值。方法：66例COPD合并Ⅱ型呼衰患者分成通气组和对照组，对照组给予常规抗感染、祛痰、平喘、肾上腺皮质激素、呼吸兴奋剂、低浓度持续吸氧等治疗，通气组除了常规治疗外，加无创机械通气（BiPAP）治疗，采用通气口鼻面罩，设定参数S／T模式，呼吸频率12～18次／min，氧流量3～5L／min，吸气压（IPAP）10～18cmH2O，呼气压（EPAP）3～6cmH2O，最初3日持续使用呼吸机，病情好转后6～20h／d，通气天数为5～12天，观察治疗前后动脉血气分析指标变化。结果：通气组治疗后血气分析中pH值、SaO2、PaO2、PaCO2较治疗前均明显改善（P〈O．01），其改善幅度明显优于对照组，临床症状亦明显改善。结论：双水平气道正压无创通气治疗COPD合并Ⅱ型呼吸衰竭疗效显著。Objective： To investigate the effectiveness of treatment with bilevel continuous airway pressure （BiPAP） ventilation on chronic obstructive pulmonary disease （COPD） complicated with type Ⅱ respiratory t＇ailure. Methods：Sixty six patients with COPD complicated with type Ⅱ respiratory failure were assigned to BiPAP plus conventional therapy （treatment group） or conventional therapy alone （control group）. Control group received conventional management con sisted of antibiotics, apophlegmatic, anticonvulsive, corticosteroids, respiratory stimulant and long-term low dose oxygen therapy. In treatment group, noninvasive BiPAP with oral-nasal mask and S/T model was administered in addition to conventional therapy. Ventilator parameters were breathing frequency of 12 to 18 bpm, oxygen flow of 3 to 5 L/min, IPAP of 10 to 18 cmH20 and EPAP of 3 to 6 cm H20. Patients in treatment group received continuous BiPAP in initial 3 days and 6 to 20 hours a day in subsequent 5 to 12 days after substantial improvement of status. Arterial blood gases were compared before and after treatment. Results ： pH, SaO2, PaO2 and PaCO2 were significantly improved after treat ment in treatment group （P〈0. 01）. There was significantly more improvement in both ventilatory parameters and symptoms in treatment group than in control group. Conclusion：BiPAP is effective to treat patients with COPD compli- cated with type Ⅱ respiratory failure.

关 键 词：无创机械通气 慢性阻塞性肺疾病(COPD) Ⅱ型呼吸衰竭 

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