双水平气道正压无创通气治疗老年慢性阻塞性肺疾病急性加重期并Ⅱ型呼吸衰竭临床观察  

Clinical observation of bi-level positive airway pressure noninvasive ventilation in treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease combined with type II respiratory failure

作　　者：曾石生[1] 李晓红[1] 张瑞侠[1] 方贤勤 夏珊珊[1] 朱坤[1] 

机构地区：[1]安徽省淮南朝阳医院呼吸科,232007

出　　处：《淮海医药》2014年第1期9-10,共2页Journal of Huaihai Medicine

摘　　要：目的评价双水平气道正压(BiPAP)无创机械通气治疗老年慢性阻塞性肺疾病急性加重期(AECOPD)合并II型呼吸衰竭患者的临床疗效。方法回顾性分析我院2009年12月-2013年5月的46例(其中18例嗜睡、1例浅昏迷)老年AECOPD合并II型呼吸衰竭患者资料,在常规治疗基础上,所有患者接受经口鼻面罩BiPAP无创机械通气。记录治疗前、治疗6 h、治疗3 d的血气分析值(PH、PaCO2、PaO2、SaO2)、呼吸频率、血压(收缩压、舒张压),并统计分析以上数据。结果经BiPAP无创机械通气治疗后患者病情明显改善,动脉血pH值较治疗前改善、氧分压(PaO2)高于治疗前、二氧化碳分压(PaCO2)低于治疗前水平,两者具有统计学意义;3 d疗效优于6 h疗效。无创机械通气对血压无明显影响。结论经口鼻面罩BiPAP无创机械通气是治疗老年COPD急性加重合并II型呼吸衰竭患者的一种安全有效的方法。Objective To study the clinical efficacy of bi-level positive airway pressure（BiPAP） noninvasive mechanical ventilation on elderly patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） combined with type Ⅱ respiratory failure. Methods A retrospective analysis was conducted on 46 cases of elderly patients of AECOPD combined with type Ⅱ respiratory failure in our hospital from December 2009 to May 2013, including 18 cases of somnolence and 1 case of superficial coma, on the basis of routine treatment. All the patients underwent BiPAP noninvasive mechanical ventilation by oral-nasal mask. Blood gas analysis （ PH, PaCO2 , PaO2 , SaO2 ） , respiratory rate and blood pressure （ both systolic and diastolic ） were recorded before treatment,6 hours and 3 days after treatment respectively, and statistics were analyzed. Results The patients with BiPAP noninvasive mechanical ventilation remarkably improved after treatment. Arterial blood pH improved compared with that before treatment. The oxygen partial pressure （ PaO2 ） was higher and the partial pressure of carbon dioxide （ PaCO2 ） lower than that before treatment, both with statistical significance. Efficacy of 3 days was better than that of 6 hours. Noninvasive mechanical ventilation had no effect on blood pressure. Conclusion BiPAP non-invasive mechanical ventilation by oral-nasal mask is a safe and effective method in treatment of elderly patients with AECOPD combined with type Ⅱrespiratory failure.

关 键 词：肺疾病 慢性阻塞性 呼吸衰竭 无创机械通气 老年人 

分 类 号：R563.19[医药卫生—呼吸系统]