无创正压通气治疗AECOPD伴呼吸衰竭、意识障碍患者的临床观察  

Clinical effects of NPPV for AECOPD patients combined with respiratory failure and awareness

作　　者：刘志强[1] 张敏[1] 陈光喜[1] 殷勤[1] 毛秀志 伍沁芳 邬红云[1] 周静[1] 

机构地区：[1]九江市第一人民医院65病区,332000

出　　处：《中华保健医学杂志》2014年第6期445-447,共3页Chinese Journal of Health Care and Medicine

摘　　要：目的探讨无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)伴呼吸衰竭、意识障碍患者的临床效果。方法以格拉斯哥昏迷评分(GCS)为标准,将我院老年病内科收治的44例AECOPD伴呼吸衰竭、意识障碍(GCS评分<10分)患者作为意识障碍组,同时选取无意识障碍(GCS评分≥10分)的AECOPD呼吸衰竭患者40例作为对照,比较两组经NPPV治疗前后的生命体征、GCS评分及动脉血气分析等指标。结果两组大多数患者能耐受NPPV治疗,意识障碍组和非意识障碍组治疗成功率分别为68.18%和85.0%(P>0.05),病死率分别为15.91%和7.50%(P>0.05);意识障碍组NPPV时间和住院时间均显著长于非意识障碍组,差异具有统计学意义(P<0.05);意识障碍组患者治疗前GCS评分、p H值、Pa O2/Fi O2水平均显著低于非意识障碍组,Pa CO2水平显著高于非意识障碍组,差异具有统计学意义(P<0.05);两组患者治疗后GCS评分、p H值、Pa O2/Fi O2水平均显著升高,Pa CO2水平显著下降,差异均具有统计学意义(P<0.05)。结论 NPPV治疗可有效改善AECOPD呼吸衰竭、伴(或不伴)意识障碍患者GCS评分、血气指标,改善患者预后。NPPV可作为AECOPD呼吸衰竭患者的一线救治方法。Objective To evaluate the clinical effects of NPPV for AECOPD patients consciousness or not combined with respiratory failure. Methods 84 AECOPD with respiratory failure patients divided into unconsciousness group （44 patients,GCS score 〈 10 points） and control group （40 patients, GCS score ≥ 10 points）,The index of vital signs indicators, GCS,index of arterial blood gas analysis were compared between two groups after NPPV. Results Most patients could tolerate NPPV. Success rate of two groups were 68.18% and 85.0% respectively （P 〉 0.05）. Mortality of two groups were 15.91% and 7.50% respectively （P 〉 0.05）. The NPPV time and hospital stays of unconsciousness group were significantly longer than consciousness group （P 〈 0.05）. The pre-treatment scores of GCS,pH,PaO2/FiO2 for unconsciousness group were significantly lower than control group （P 〈 0.05）. The score of PaCO2 for unconsciousness was significantly higher than control group （P 〈 0.05）. The post-treatment scores of GCS,pH,PaO2/FiOg for the two groups were higher than pre-treatment significantly （P 〈 0.05）. The post-treatment levels of PaCO2 for two groups were lower than pretreatment （P 〈0.05）. Conclusion NPPV can improve the GCS,index of arterial blood gases,vital signs indicators for the AECOPD with respiratory failure patients consciousness or not. NPPV can be a first choice method for AECOPD with respiratory failure patients.

关 键 词：无创正压通气 慢性阻塞性肺疾病 呼吸衰竭 意识障碍 

分 类 号：R45[医药卫生—治疗学] R56[医药卫生—临床医学]