无创正压通气治疗Ⅱ型呼吸衰竭时呼出气潮气量与通气效果的临床研究  

Clinical research on exhaled gas tidal volume and ventilatory effects of noninvasive positive pressure ventilation in the treatment of type Ⅱ respiratory failure

作　　者：王蓉美[1] 王肇源[1] 隋东江[1] 李凤芝[1] 刘莹[1] 李海燕[1] 赵海霞[1] 张波[2] 

机构地区：[1]空军总医院干部病房,北京100142 [2]空军总医院呼吸内科,北京100142

出　　处：《国际呼吸杂志》2012年第23期1791-1794,共4页International Journal of Respiration

摘　　要：目的探讨无创正压通气（NIPPV）治疗慢性阻塞性肺疾病急性加重（AECOPD）伴Ⅱ型呼吸衰竭患者时不同呼出气潮气量水平对通气效果的影响。方法选取伴Ⅱ型呼吸衰竭的住院患者45例，在常规治疗基础上，给予沙利文多功能双水平无创正压呼吸机（VPAP Ⅱ ST—A BI—LEVEL）辅助通气。观察患者呼出气潮气量，并根据呼出气潮气量将患者分为A、B、C三组，监测三组患者治疗前及治疗2h后的动脉血气、心率和呼吸频率变化。结果A组患者，治疗前和治疗后2h的动脉血气分析和临床指标基本无变化（P〉0．05），PaCO2下降幅度小，仅下降1．02％，并有4例患者PaCO2不降反升，病情加重，给予气管插管和有创呼吸机辅助通气；B组与C组患者，辅助通气2h后动脉血气分析和临床指标明显改善，尤以PaCO2下降明显（P〈0．01），下降幅度超过20％。结论监测NIPPV治疗时患者呼出气潮气量，可以直接、及时反映通气效果，并指导通气参数的设置。Objective To investigate the influence of ventilatory effect caused by exhaled gas tidal volume during the treatment of noninvasive positive pressure ventilation （NIPPV） towards patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and Ⅱ respiratory failure. Methods 45 patients with AECOPD and type Ⅱ respiratory failure were selected in the study. Beside the basis of conventional therapy, the patients were also given ventilation by Sullivan＇s multi-function bi-level noninvasive positive pressure ventilator （VPAP Ⅱ ST A, the BI the LEVEI.）. We divided these patients into group A, B, C by their exhaled tidal volume （VTe）. Then we monitored these patients＇ arterial blood gas, heart rate and breathing frequency before and after this treatment. Results Before and after the treatment, group A of arterial blood gas and clinical indicators are almost no change （ P〉0.05）, and their PaCO2 is decreased 1.02% only. 4 patients in group A were given endotracheal intubation and invasive mechanical ventilation due to the increase of their PaCO2. After 2 hours ventilation treatment, group B and C patients＇ arterial blood gas and clinical parameters were significantly improved, especially PaCO2 decreased significantly （ P〈0.01）, by more than 20%. Conclusions During NIPPV treatment, the patients＇ exhaled tidal volume is directly related to the ventilation effects, and they can be used to guide the ventilation parameter settings.

关 键 词：无创正压通气 呼出气潮气量 慢性阻塞性肺疾病 Ⅱ型呼吸衰竭 

分 类 号：R563.9[医药卫生—呼吸系统]