双水平气道正压通气对慢性肺源性心脏病急性加重期疗效的观察  

Curative effect observation of bi-level positive airway pressure ventilation on acute exacerbation of chronic pulmonary heart disease

作　　者：王永[1] 刘勇[1] 朱宝山[1] 

机构地区：[1]江苏省新沂市铁路医院呼吸科,221400

出　　处：《中华肺部疾病杂志（电子版）》2014年第1期55-58,共4页Chinese Journal of Lung Diseases(Electronic Edition)

摘　　要：目的探讨经面罩双水平气道正压通气(BiPAP)呼吸机治疗慢性肺源性心脏病急性加重期(AECPHD)患者的临床疗效。方法 92例AECPHD患者随机分为治疗组和对照组,各46例。两组均常规综合治疗,给予控制感染、营养支持、纠正酸碱平衡及水、电解质紊乱、解痉平喘、止咳祛痰,应用利尿剂、洋地黄以及扩血管药物等。对照组加持续低流量氧疗,治疗组加面罩BiPAP呼吸机治疗。观察两组临床症状、生命体征、血气指标、心功能分级、面罩舒适度、漏气情况及不良反应。结果①治疗组治疗后心率、呼吸频率、动脉血二氧化碳分压及pH值均明显下降,住院天数缩短,PaO2、SaO2明显上升,与对照组相比差异具有统计学意义(P<0.01);②治疗组总有效率93.5%(43/46)与对照组76.1%(35/46)相比差异有统计学意义(P<0.05);③治疗组3例治疗72 h后症状改善不明显,2例120 h后逐渐好转,死亡1例。对照组11例经治疗72 h后症状无明显改善,行气管插管进行有创机械通气,平均通气时间为(7.9±1.8)d,死亡6例;④治疗组患者有2例出现轻度腹胀,休息后逐渐缓解。4例患者因面部压迫有不适感觉,调整面罩松紧后不适感缓解。结论早期应用BiPAP呼吸机治疗AECPHD患者,可防止病情恶化、避免气管插管,降低病死率。BiPAP具有操作简单、容易掌握、痛苦小、缩短住院时间等优点,可作为早期治疗AECPHD患者的一种安全、有效的方法。Objective To discuss the curative effect by mask bi-level positive airway pressure （BiPAP） ventilator for acute exacerbation of chronic pulmonary heart disease （AECPHD）. Methods A total of 92 AECPHD patients were randomly divided into treatment group and control group. The two groups were given routine treatment, to control infection, nutritional support, correction of acid-base balance and water, electrolyte disturbances, antispasmodic asthma, cough expectorant, diuretics, digitalis, vasodilators. The control group with persistent low flow oxygen therapy, treatment group plus mask BiPAP ventilation therapy. Clinical symptoms, vital signs, blood gas analysis, cardiac functional grading, mask comfort, leakage and adverse reaction. Results （1） In the treatment group after treatment, heart rate, respiratory rate, arterial partial pressure of carbon dioxide and pH value were decreased significantly, thus shortening the duration of hospitalization, PaO2, SaO2 were increased significantly compared with the control group, the differences were statistically significant （P 〈 0.01 ） ; （2）In the treatment group the total effective rate was 93.5% （43/46） and the control group 76.1% （ 35/46 ） had significant difference （ P 〈 0.05 ） ; （3）The treatment group of 3 cases after 72 h treatment had not obvious symptom improvement, 2 cases after 120 h gradually improved, 1 cases of death. 11 cases of the control group after treatment for 72 h without obvious symptoms improve, endotracheal intubation for mechanical ventilation, the median duration of ventilation was （7.9 ±1.8 ） d, 6 eases of death ; （4）The patients in the treatment group with 2 cases had mild abdominal distension, rest after gradually ease. 4 patients with facial oppression feeling is unwell, adjust mask elastic discomfort after remission. Conclusions Application of BiPAP in treating AECPHD patients early, can prevent the deterioration of the disease, to avoid endotracheal intubation, reduce the mortality rate. It has t

关 键 词：心脏病 慢性肺源性 无创通气 双水平气道正压通气 治疗 

分 类 号：R563[医药卫生—呼吸系统]