无创正压通气在不气管插管慢性阻塞性肺疾病并呼吸衰竭患者中疗效观察  

Observational study of noninvasive positive pressure ventilation (NPPV) in the patients with "do-not-intubate" orders due to acute exacerbation of chronic obstructive pulmonary disease.

作　　者：杨玉梅[1] 王以炳[1] 夏蕾[1] 

机构地区：[1]武汉科技大学附属天佑医院呼吸内科,湖北武汉430064

出　　处：《四川医学》2010年第11期1604-1606,共3页Sichuan Medical Journal

摘　　要：目的观察无创正压通气(noninvasive positive-pressure ventilation,NPPV)治疗不气管插管慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并急性呼吸衰竭患者的临床疗效。方法开展采用NPPV治疗COPD合并急性呼吸衰竭伴意识障碍有气管插管指征、拒绝气管插管患者疗效的前瞻性观察研究。27例COPD伴意识障碍患者为研究组,13例意识清醒患者为对照组,观察NPPV治疗前、治疗4h及72h后的临床症状和血气分析及住院病死率。结果不同程度意识障碍者27例BiPAP无创通气4h后18例(67.7%)好转,无意识障碍患者中92.9%(12/13)BiPAP无创通气治疗成功。结论 NPPV可以有效地逆转选择不插管的COPD合并急性呼吸衰竭。Objective To observe the efficacy of noninvasive positive pressure ventilation（NPPV） in the patients with ＂do-not-intubate（DNI）＂ orders due to chronic obstructive pulmonary disease（COPD） exacerbations.MethodsProspective observational study was conducted in respiratory department.NPPV was provided with DNI patients with acute respiratory failure secondary to COPD exacerbations,not improving under conventional medical therapy and on the edge of intubation.27 patients with COPD with conscious disturbance were treated by NPPV after refusing intubation,hospital mortality of these patients was compared to that of 13 COPD subjects with hypercapnic decompensation（control group） treated with NPPV who were awake.Results18 of the 27 cases with different degrees of conscious disturbance responded well to BiPAP therapy,while 12（92.9%） of 13 cases succeeded in control.Conclusion NPPV is effective for reversing acute respiratory failure and preventing hospital mortality in Patients with DNI orders secondary to COPD.

关 键 词：无创正压通气 慢性阻塞性肺疾病 急性呼吸衰竭 

分 类 号：R563.9[医药卫生—呼吸系统]