无创正压机械通气治疗老年人慢性阻塞性肺疾病并发呼吸衰竭的疗效观察  

Clinical efficacy of noninvasive positive pressure ventilation on elderly chronic obstructive pulmonary patients with respiratory failure

作　　者：文辉[1] 孔令贵[1] 邢汉飞[1] 杜宝青[1] 

机构地区：[1]滨州市中心医院呼吸内科,山东省滨州251700

出　　处：《中国基层医药》2015年第12期1877-1879,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：观察无创正压机械通气治疗对老年人慢性阻塞性肺疾病并发呼吸衰竭患者临床疗效。方法收集64例老年慢性阻塞性肺疾病并发呼吸衰竭患者为研究对象，患者给予常规治疗，同时采用BiPAP 呼吸机经口鼻面罩行双水平无创正压通气治疗，并给予有效护理。治疗3 d 后，比较观察64例患者治疗前后 pH、PaO2、PaCO2、SaO2指标变化，呼吸、心率的变化及 APACHEⅡ、GCS 及辅助呼吸肌评分情况，记录通气治疗中不良反应。结果经过治疗后，患者的 pH 值由治疗前的（7．30±0．06），明显升高到（7．36±0．03），PaO2值由治疗前（43．58±5．54）mmHg，明显升高到（84．52±8．27）mmHg，SaO2值由治疗前（74．86±7．25）％，明显升高到（94．93±5．61）％，PaCO2值由治疗前（71．69±8．48）mmHg，明显降低到（42．55±6．23）mmHg，差异均有统计学意义（t ＝5．98、6．35、4．86、7．23，均 P ＜0．05），呼吸频率、心率均有明显改善，差异有统计学意义（t ＝4．87、5．32，均 P ＜0．05），APACHE Ⅱ、GCS 及辅助呼吸肌评分均有明显改善，其中APACHEⅡ、辅助呼吸肌评分显著降低，GCS 评分显著增加，差异均有统计学意义（t ＝4．09、4．01、4．33，均 P ＜0．05）。结论无创正压机械通气治疗能改善老年慢性阻塞性肺疾病并发呼吸衰竭患者临床症状，增加通气量及改善高碳酸血症，临床疗效较好，无严重不良反应。Objective To investigate the clinical efficacy of noninvasive positive pressure ventilation for eld-erly patients with chronic obstructive pulmonary disease and respiratory failure.Methods A total of 64 elderly patients with chronic obstructive pulmonary disease and respiratory failure were collected.The patients were treated with conventional therapy,while using BiPAP ventilator line through the nose and mouth mask bilevel noninvasive pos-itive pressure ventilation therapy,and to give effective care.After treatment for 3d,the pH,PaO2 ,PaCO2 ,SaO2 index changes,respiration,heart rate changes and APACHE Ⅱ,GCS and accessory muscle score were observed.Adverse reactions were recorded.Results Before treatment the PH value of patient was （7.30 ±0.06）,which significantly increased to （7.36 ±0.03 ）after treatment,PaO2 values was significantly increased to （43.58 ±5.54）from （84.52 ±8.27）,SaO2 value was significantly increased to （94.93 ±5.61）from （74.86 ±7.25）,PaCO2 value from （71.69 ±8.48）decreased to （42.55 ±6.23）.There was statistically significant before and after treatment （t =5.98,6.35,4.86,7.23,all P 〈0.05）,respiratory rate,heart rate were significantly improved,showing a significant difference （t =4.87,5.32,all P 〈0.05 ）,APACHE Ⅱ,GCS and accessory muscle scores were significantly improved,which APACHEⅡ,accessory muscle score was significantly lower,GCS score was significantly increased, were statistically significant （t =4.09,4.01,4.33,all P 〈0.05）.Conclusion It shows that noninvasive positive pressure ventilation combined with conventional drug therapy can improve elderly patients with chronic obstructive pulmonary disease and respiratory failure in patients with clinical symptoms,increase ventilation and improve hyper-capnia,clinical efficacy is better,with no serious adverse reactions.

关 键 词：呼吸衰竭 无创正压通气 肺疾病 慢性阻塞性 

分 类 号：R766.43[医药卫生—耳鼻咽喉科]