低压力水平，BiPAP治疗AECOPD合并Ⅱ型呼吸衰竭的临床研究  

Clinical study of low pressure BiPAP ventilation on patients with acute exacerbation of chronic obstructive pulmonary diseases combined with type Ⅱ respiratory failure.

作　　者：蔡毅峰[1] 陈楚芬[1] 郑锐林[1] 李春慧[1] 

机构地区：[1]潮州市中心医院,广东潮州521000

出　　处：《中外医学研究》2009年第6期14-15,共2页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的探讨低压力水平BIPAP在慢性阻塞性肺疾病急性加重期（AECOPD）并Ⅱ型呼吸衰竭患者治疗中的有效性和安全性。方法对40例AECOPD并Ⅱ型呼吸衰竭的住院患者在常规抗感染、扩张气道、止咳、祛痰及适当应用糖皮质激素基础上给予尽可能低的压力支持水平（维持潮气量4—7ml／kg，同时SaO2〉90％的最低IPAP，EPAP≤5cmH2O）的BIPAP治疗；通过观察患者通气前后的动脉血气（pH、PaO2、PaCO2、SaO2）及呼吸频率的变化判断临床疗效。结果40例AECOPD并Ⅱ型呼吸衰竭患者中，经面罩BiPAP治疗后34例患者动脉血气、呼吸频率指标得到改善，pH、PaO2、SaO2较入院时明显升高，PaCO2和呼吸频率明显降低，且差异有显著性意义（P〈0．05）。结论BIPAP治疗可以改善AECOPD并Ⅱ型呼吸衰竭患者的生命体征及动脉血气指标，帮助此类患者减轻呼吸肌疲劳，防止呼吸衰竭进一步加重，并减少气管插管率，是治疗慢性阻塞性肺疾病急性加重期并Ⅱ型呼吸衰竭患者经济有效的方法；低压力支持水平（维持潮气量4～7ml／kg，同时SaO2〉90％的最低IPAP，EPAP≤5cmH2O）的BIPAP治疗成功率与更高压力支持水平患者成功率相同，且患者人机协调性更好，依从性、耐受性更好，副作用更少，更加安全。Objective To study the effect and security of low pressure BiPAP ventilation on the patients with acute exacerbation of chronic obstructive pulmonary diseases （AECOPD） combined with type Ⅲ respiratory failure. Methods Forty patients with AECOPD combined with type Ⅱ respiratory failure were received the lowest level pressure Bilevel Positive Airway Pressure（BiPAP） ventilation,which IPAP can keep tidal volume between 4 - 7ml/kg and keep SaO2 〉 90%, EPAP ≤ 5cm H2O. Observation was made on the changes of Respiratory rate （RR） and arterial blood gas parameters （pH ,PaO2 ,PaCO2 ,SaO2 ） before and after treatment. Results Among 40 cases,34 patients＇ respiratory rate（RR） and arterial blood gas parameters （pH,PaO2 ,PaCO2 ,SaO2 ） improved markedly. The pH,PaO2 ,SaO2 were improved significantly （P 〈0.05 ） , RR .PaCO2 were decreased obviously （ P 〈 0.05 ） after ventilation. Conclusion BiPAP ventilation is an effectively and economic treatment of AECOPD combined with type Ⅱ respiratory failure. It can improve respiratory rate（RR） and arterial blood gas parameters （pH,PaO2 ,PaCO2 , SaO2 ） markedly, help patients to reduse the tiredness of respiratory muscle, prevent the depravation of respiratory failure. Low pressure BiPAP ventilation ,which IPAP can keep tidal volume between 4 -7ml/kg and keep SaO2 〉 90%, EPAP ≤ 5cmH2O, has the same effect with the high pressure BiPAP ventilation, and the same time,it has better security and less side effects than the high pressure BiPAP ventilation. Patients will feel more comfortable, have more compatibility, compliance and tolerance.

关 键 词：BiPAP呼吸机慢性阻塞性肺病 Ⅱ型呼吸衰竭 无创正压通气 

分 类 号：R563.805[医药卫生—呼吸系统] R563.8[医药卫生—内科学]