无创与有创通气治疗慢性阻塞性肺疾病急性加重的疗效分析  

Comparison of non-invasive and invasive ventilation on acute exacerbations of chronic obstructive pulmonary diseases

作　　者：刘杨[1] 马少林[1] 沈桢巍[1] 

机构地区：[1]同济大学附属东方医院中心ICU,上海200120

出　　处：《同济大学学报（医学版）》2010年第1期69-72,共4页Journal of Tongji University(Medical Science)

摘　　要：目的评价无创与有创通气对于慢性阻塞性肺疾病急性加重(acute exacerbations of chronic obstructivepulmonary diseases,AECOPD)患者的治疗效果。方法59例AECOPD患者按早期使用机械通气方式随机分为有创组(28例)和无创组(31例),观察患者机械通气前后血气分析指标,Glasgow昏迷评分(Glasgow coma scale,GCS),以及机械通气时间。结果有创组机械通气2 h后,pH、p_aO_2明显上升,p_aCO_2明显下降(P<0.05);无创组机械通气2 h后,p_aO_2明显上升(P<0.05),pH及p_aCO_2无明显改变(P>0.05)。使用机械通气12 h后,无创组p_aCO_2与pH均明显好转(P<0.05)。有创组机械通气时间较无创组更长(P<0.05)。对无创组进行亚组分析,最终需要改有创通气的患者在早期入院时血气分析较可坚持使用无创通气的患者有更低的pH及更高的p_aCO_2(P<0.05)。结论早期有创通气对AECOPD患者血气分析改善优于无创通气;机械通气12 h后,两种通气方式对血气指标的改善作用相似。有创通气者可能需更长机械通气时间。早期p_aCO_2、pH的水平可作为评价患者最终是否需要插管的指标。Objective To evaluate the effects of non-invasive ventilation and invasive ventilation on acute exacerbations of chronic obstructive pulmonary diseases （AECOPD）. Methods Fifty-nine patients were randomly divided into 2 groups accroding the methods of mechanical ventilation, non- invasive ventilation （NIVG） group （31 patients） and invasive ventilation （IVG） group （28 patients）. The result of blood gas analysis, Glasgow coma scale （GCS） and mechanical ventilation time were observed and compared. Results After 2 hours of ventilation, pH and paC02 increased （P〈0.05） and paO2 decreased significantly in patients with IVG （P〈0.05）; while paO2 increased significantly in patients with NIVG （P〈0.05）, but pH and p^CO2 had no obviously changes （P〉0.05）. After 12 hours of ventilation, paCO2 and pH of patients in NIVG group were better （P〈0.05）. The ventilation time in IVG group was longer than that in NIVG group. On the subgroup analysis of NIVG, those patients needed invasive ventilation later had a lower pH and higher paCO2 at the beginning （P〈0.05）. Conclusion Compared with NIVG, IVG has a better effect on pH, paO2 and paCO2 at the early stage of mechanical ventilation. But after 12 hours of ventilation, the 2 strategy have almost same effects. Patients in IVG group need a longer ventilation time. The levels of paCO2 and pH at the beginning can be good indices on whether the patient needs intubation.

关 键 词：慢性阻塞性肺疾病 急性发作期 无创机械通气 有创机械通气 血气分析 GLASGOW昏迷评分 

分 类 号：R563.9[医药卫生—呼吸系统]