双水平无创正压通气治疗慢性阻塞性肺疾病急性加重期并发呼吸衰竭的疗效观察  

Observation of the effect of bi-level noninvasive positive pressure ventilation in the treatment of acute respiratory chronic obstructive pulmonary disease patients with respiratory failure

作　　者：李波[1] 陈明贤[1] 

机构地区：[1]枣阳市第一人民医院呼吸内科,湖北省枣阳441200

出　　处：《中国基层医药》2014年第3期358-360,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 观察双水平无创正压通气（BiPAP）对COPD急性加重期合并呼吸衰竭患者的疗效.方法 采用11病例匹配选择COPD急性加重期合并呼吸衰竭患者60例,对照组30例给予常规治疗,观察组30例在对照组基础上给予BiPAP治疗,比较两组治疗前、治疗后2、24、48 h的RR、HR及SaO2、pH值,PaO2、PaCO2以及急性生理和慢性健康状况（APACHE Ⅱ）评分和辅助呼吸机评分的变化情况,并比较两组患者的生存率.结果 观察组在治疗后2、24、48 h的SaO2、pH值、PaO2均高于对照组（t=4.46、3.82、3.49、2.97、4.08、7.75、5.09、3.72、4.13,均P＜0.01）,治疗后24、48 h的RR低于对照组（t=2.63、3.81,均P＜0.01）.观察组治疗48 h后APACHE Ⅱ评分为（16.7±1.2）分,低于对照组的（18.9±1.1）分（t=6.73,P＜0.01）;辅助呼吸机评分为（3.0±0.5）分,低于对照组的（3.5±0.6）分（t=3.51,P＜0.01）.观察组病死率为6.66%,对照组的病死率为36.66%,观察组生存率高于对照组（χ^2=6.054,P＜0.05）.结论 BiPAP治疗COPD合并呼吸衰竭患者临床效果好,在临床应用中应在掌握患者病情的前提下优先考虑应用.Objective To evaluate the efficacy of the bi-level noninvasive positive pressure ventilation （ BiPAP） for acute chronic obstructive pulmonary disease （COPD） patients with respiratory failure. Methods 1 .： 1 match was used to select 60 COPD patients with respiratory failure of cases （treatment group） ,30 cases in the control group were given conventional treatment. 30 patients in the treatment group were given BiPAP on the basis of conven- tional treatment. Before treatment and 2h ,24h,48h after treatment, the respiratory rate （RR）, heart rate （HR） and ar- terial oxygen saturation （ SaO2 ）, pH value, PaO2, PaCO2, and acute physiology and chronic health evaluation （ A- PACHE II ） score and auxiliary ventilator score changes were compared between the two groups. Results 2h,24h, 48h after treatment, the SaO2 , pH, PaO2 of the treatment group were significantly higher than those of the control group （ t = 4.46,3.82,3.49,2.97,4.08,7.75,5.09,3.72,4.13, all P 〈 0.01 ） ;24h ,48h after treatment, RR of the treat- ment group was significantly lower than that of the control group（ t = 2.63,3.81, all P 〈 0.01 ）. 48h after treatment, the APACHE II score of the treatment group was significandy lower than the control group[ （ 16.7 ± 1.2） points vs （ 18.9 ± 1.1 ） points, t = 6.73, P 〈 0. 01 ] ; the auxiliary ventilator score of the treatment group was significantly lower than the control group [ （ 3.0 ±0. 5 ） points vs （3.5 ± 0.6） points, t = 3.51, P 〈 0. 01 ]. The mortality rate of the treatment group was 6.66% and that was 36.66% in the control group, the survival rate of treatment group was higher than control group （ t = 6. 054, P 〈 0.05 ）. Conclusion The BiPAP was effective for treatment of elderly COPD patients with respiratory failure, it should be given priority under the premise of understand the overall condition of patients in the clinical application.

关 键 词：肺疾病 慢性阻塞性 呼吸功能不全 通气机 机械 正压呼吸 

分 类 号：R563.9[医药卫生—呼吸系统]