无创性目标潮气量机械通气治疗COPD伴重度CO_2潴留的疗效观察  

Clinical observation of noninvasive target volume ventilation in the treatment of chronic obstructive pulmonary disease with severe CO_2 retention

作　　者：李威[1] 林盪[1] 陈燕明[1] 陈晓军[1] 吴允孚[2] 

机构地区：[1]南京医科大学附属苏州医院呼吸内科,江苏苏州215006 [2]南京医科大学附属苏州医院ICU科,江苏苏州215006

出　　处：《临床肺科杂志》2013年第1期71-72,共2页Journal of Clinical Pulmonary Medicine

基　　金：南京医科大学科技发展基金项目(09NJMUM141);苏州市科技应用基础研究项目(SYS201050)

摘　　要：目的探讨无创性目标潮气量机械通气在慢性阻塞性肺病伴重度CO2潴留患者中的治疗效果。方法呼吸科及ICU科收治的16例COPD病人资料,均PaCO2>80 mmHg的COPD伴Ⅱ型呼衰患者,在常规药物治疗及氧疗基础上,应用无创性目标潮气量机械通气治疗,通过自身对照观察患者无创通气治疗前、后血气指标变化和病情改善程度。结果 16例患者中3例不能耐受无创通气,放弃治疗,11例使用无创后好转,病情稳定出院,2例无创通气失败,改行气管插管,死亡1例。患者无创通气治疗2 h后血气指标明显改善,PaCO2显著下降(P<0.05),48 h后病情明显好转。结论无创性目标潮气量机械通气可显著改善COPD伴重度CO2潴留患者高碳酸血症,疗效肯定。Objective To investigate the therapeutic effect of noninvasive target volume ventilation in the treatment of COPD patients with severe CO2 retention. Methods 16 COPD patients with serious CO2 retention （PaCO2 〉 80 mmHg） were given the noninvasive target volume ventilation treatment and the conventional therapy, and then the changes of blood gases before and after the treatment were analyzed. Results 3 patients gave up the noninvasive target volume ventilation treatment because they couldn＇t take it. 11 patients turned better and were discharged from hospital. The rest 2 patients failed to give noninvasive ventilation and then was given trachea cannula instead, which led to one death. The blood gases were improved significantly and the concentration of PaCO2 decreased clearly after 2-hour treatment （P 〈 0. 05 ）. After 48 hours, the patients＇ conditions all turned better. Conclusion The noninvasive target volume ventilation treatment combined with conventional therapy can definitely improve the situation of COPD patients with severe CO2 retention and it＇s worth to be applied in clinical practise.

关 键 词：慢性阻塞性肺病 重度高碳酸血症 无创正压通气 目标潮气量 

分 类 号：R563.9[医药卫生—呼吸系统]