无创正压机械通气治疗慢性阻塞性肺疾病失败病例分析  

Analysis of failure of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary diasease

作　　者：杨春红[1] 李琦[1] 肖琅[1] 

机构地区：[1]天津市第三中心医院院呼吸科,300170

出　　处：《临床内科杂志》2009年第6期392-394,共3页Journal of Clinical Internal Medicine

摘　　要：目的探讨无创正压机械通气（NIPPV）治疗慢性阻塞性肺疾病（COPD）伴Ⅱ型呼吸衰竭失败病例的相关因素，为NIPPV临床应用提供可能的依据。方法将91例COPD患者分为成功组和失败组。监测两组患者的生命体征、血气分析、血常规、电解质、肝肾功能等指标，多因素分析患者年龄、呼吸衰竭病程、合并症。观察患者的依从性、上机后开始床旁监测时间、应用呼吸机早期病情的变化。结果在NIPPV早期依从性方面，失败组明显低于成功组，失败组初次使用呼吸机的监护时间明显低于成功组。在APACHEⅡ评分方面，失败组明显高于成功组。两组初始血气分析指标比较无明显差异。但随着通气时间的延长，成功组明显好转，而失败组无明显变化。NIPPV在抢救COPD引起的呼吸衰竭成功率为74．72％，两组其余指标比较差异有统计学意义。结论NIPPV在抢救COPD伴Ⅱ型呼吸衰竭有重要的临床价值，使用NIPPV可早期监测患者的病情变化。Objective To analyse the predictors of failure of noninvasive positive pressure ventilation（NIPPV） in the patients with chronic obstructive pulmonary diasease（COPD）. Methods 91 cases treated with NIPPV were divided into cure group and failure group. Arterial blood gas, complete blood count, liver function, kidney function, electrolyte and vital signs were measured. The multiple factors included age, time course of respiratory failure, fundamental diseases, compliance, time point of bedside monitor, and the changes of syndromes during the early period with NIPPV. The fundamental diseases were scored by APACHE Ⅱ and consciousness conditions were estimated by GCS system. Results Compared with cure group, the patients in failure group presented obviously worse compliance and shorter monitor time with higher score of APACHE. There was no difference in arterial blood gas before NIPPV between two groups ,however, the patients in cure group improved significantly along with NIPPV. The efficacy of NIPPV in the patients with respiratory failure clue to COPD was 74.72%. There are significantly difference between two groups in other lab investigation. Conclusions This study showed that NIPPV played a key role in respiratory failure. The early monitoring in patients with NIPPV is important.

关 键 词：无创正压机械通气 慢性阻塞性肺疾病 

分 类 号：R563[医药卫生—呼吸系统]