无创通气在老年慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭中的临床应用  

Clinical application of non-invasive ventilation in chronic obstructive pulmonary disease associated with type Ⅱ respiratory failure in elderly patients

作　　者：陈建强[1] 

机构地区：[1]南京医科大学附属江苏盛泽医院急诊科,江苏苏州215228

出　　处：《实用临床医药杂志》2014年第21期23-25,30,共4页Journal of Clinical Medicine in Practice

基　　金：中国高校医学期刊临床专项资金(11321576)

摘　　要：目的观察无创通气(NIV)治疗老年慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者的临床疗效。方法选取65例老年COPD合并呼吸衰竭患者,随机分为观察组33例与对照组32例。2组均给予祛痰、抗感染、扩张支气管等常规治疗,对照组在此基础上给予持续低流量吸氧,观察组在此基础上给予NIV治疗。观察2组临床症状改善情况,治疗前、治疗3 h后及7 d后的呼吸频率(RR)、心率(HR)、动脉血气分析、临床肺部感染评分(CPIS)及急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分等指标变化。结果观察组症状改善率87.88%,高于对照组的81.25%,但差异无统计学意义(P>0.05);2组治疗前RR、HR、动脉血气分析、CPIS及APACHEⅡ评分无显著差异(P>0.05);治疗3 h、7 d后,2组上述指标均较治疗前显著改善(P<0.05或P<0.01),组间比较差异显著(P<0.01)。结论 NIV对老年COPD合并Ⅱ型呼吸衰竭患者的疗效确切,在纠正低氧血症、改善二氧化碳潴留、呼吸性酸中毒及改善肺功能方面显著优于鼻导管吸氧。Objective To observe the clinical application of non-invasive ventilation （NIV） in treatment of chronic obstructive pulmonary disease （COPD） associated with type Ⅱ respiratory failure in elderly patients in elderly patients. Methods 65 elderly COPD patients associated with type Ⅱ respiratory failure were divided into observation group （ n = 33） and control group （ n = 32）. Both groups were treated with regular treatment of expectorant, anti-infection and bronchodilated. On this basis control group was given continuous low flow oxygen, while observation group obtained NIV. The improvement of clinical symptoms in both groups were observed. Before the start, 3 hours and 7 days after treatment, the respiratory rate （RR）, heart rate（HR） and arterial blood gas, clinical pulmonary infection score （CPIS） and the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） were assessed. Results Symptom improvement rate was 87.88% in observation group, which was higher than 81.25 % in control group （P 〉 0.05）. The RR, HR, arterial blood gas, CPIS and APACHE Ⅱ score compared between the 2 groups before treatment. While 3 hours and 7 days after treatment, the above indexes obviously improved （P〈0.05 or P〈 0.01） and there was a significant difference between groups （P 〈 0.01 ）. Conclusion NIV is effective in COPD associated with type Ⅱ respiratory failure in elderly patients. The effects of NIV in rectifying the hypoxemia, improving the carbon dioxide retention and respiratory acidosis, improving lung function are significantly better than the nasal cannula oxygen.

关 键 词：无创通气 慢性阻塞性肺疾病 Ⅱ型呼吸衰竭 临床肺部感染评分 急性生理学和慢性健康状况评分系统Ⅱ 

分 类 号：R441.8[医药卫生—诊断学]