无创机械通气在慢性阻塞性肺疾病并发呼吸衰竭治疗中的应用  

Application of non-invasive ventilation in treating COPD patients with respiratory failure

作　　者：周文柱[1] 

机构地区：[1]北京中日友好医院急诊外科,北京市100029

出　　处：《中国基层医药》2010年第2期166-167,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的观察早期应用无创机械通气治疗慢性阻塞性肺疾病（COPD）并发呼吸衰竭的疗效。方法58例COPD并发呼吸衰竭患者，根据开始使用无创机械通气治疗时间的不同，分为早期应用组（Ⅰ组27例）及非早期应用组（Ⅱ组31例），比较两组患者病情好转时间、机械通气时间、有效率、气管插管率和病死率等。结果58例患者中有54例经无创机械通气治疗后，临床症状明显改善，呼吸频率及心率明显减慢，氧饱和度和动脉血氧分压明显增加，二氧化碳分压恢复到正常水平，动脉血pH恢复正常，与治疗前比较差异有统计学意义（P〈0．05）。Ⅰ组病情好转时间（2．3±1．1）h、机械通气时间（5．9±2．7）h，与Ⅱ组的（5．7±3．2）h、（9．8±4．3）h比较，差异均有统计学意义（t=7．38、5．64，均P〈0．01）；Ⅰ组全部治愈（100％），无气管插管及死亡病例，Ⅱ组27例治愈（87％），气管插管4例，其中死亡2例（6％），两组比较差异均有统计学意义（P〈0．05或P〈0．01）。结论采用无创机械通气治疗COPD并发呼吸衰竭疗效确切，早期应用可提高治愈率。Objective To evaluate the clinical value of early use of non-invasive ventilation in chronic ob- structive pulmonary disease（COPD） patients with respiratory failure. Methods Totally 58 patients with COPD induced respiratory failure, admitted from January 2007 to June 2009, received B/PAP non-invasive ventilation treatment, and were retrospectively studied. The changes of respiration rate, heart rate, arterial blood gas before and after non-invasive ventilation application were compared. According to the application time of non-invasive ventilation,58 patients were divided into two groups ： group I （ early application group, n = 27 ） and group Ⅱ （ non-early application group, n = 31 ）. The time to improve the symptoms, the application time of non-invasive ventilation, cure rate, tracheal intubation rate and mortality were compared between the two groups. Results Non-invasive ventilation was applied on 54 patierts effectively. Their respiratory rate, heart rate significantly decreased, PH, PaO2 and SaO2 significantly increased and PaCO2 significantly decreased（ P 〈 0.05 ）. The tracheal intubation was performed in 4 patients. The time needed to improve the symptoms and the application time of non-invasive ventilation were significantly different between group Ⅰ and group 1/（t =7.38,5.64,all P 〈0.01 ）. In group Ⅰ , all patients were cured,no tracheal intuba tion. In group Ⅱ ,27 patients were cured,4 patients equired tracheal intubation,and 2 died. Conclusion Non-invasive ventilation application is effective in the treatment of COPD patients with respiratory failure. Early application can increase the cure rate and reduce mortality.

关 键 词：肺疾病 慢性阻塞性 通气机 机械 呼吸功能不全 

分 类 号：R563[医药卫生—呼吸系统] R473.5[医药卫生—内科学]