无创正压机械通气治疗矽肺合并呼吸衰竭疗效观察  

Curative effect of noninvasive positive pressure ventilation in treatment of silicosis complicated with respiratory failure

作　　者：贺今[1] 于永红[1] 李巧玲[1] 

机构地区：[1]济南医院,山东济南250013

出　　处：《中国职业医学》2015年第4期403-405,共3页China Occupational Medicine

摘　　要：目的观察无创正压机械通气治疗矽肺壹期、贰期患者合并Ⅱ型呼吸衰竭的临床疗效。方法对6例矽肺(4例矽肺壹期,2例矽肺贰期)合并Ⅱ型呼吸衰竭并反复发生肺性脑病的患者,在应用抗感染和呼吸兴奋剂等治疗的基础上予无创正压机械通气,比较呼吸机治疗前后动脉血气指标及临床症状改善情况。结果无创正压机械通气治疗后,6例患者动脉血二氧化碳分压和二氧化碳总量均较治疗前下降(P<0.01),动脉血氧分压和氧饱和度均较治疗前增高(P<0.01);p H值基本恢复正常,呼吸性酸中毒得到纠正;但治疗前碳酸氢根水平与治疗后比较,差异无统计学意义(P>0.05)。6例患者治疗过程中无出现不能耐受机械通气治疗和脱机困难情况,经治疗后呼吸困难均消失,均无出现意识障碍,好转出院。结论无创正压机械通气治疗可改善矽肺合并呼吸衰竭且药物治疗效果欠佳患者肺通气功能,是一种安全、有效的治疗方法。Objective To observe the clinical efficacy of noninvasive positive pressure ventilation （NPPV） applied in treatment of silicosis patients （the first stage and the second stage） complicated with type 1] respiratory failure. Methods After having therapy of anti-infection and respiratory stimulant, 6 cases of silicosis patients （4 cases at the first stage and 2 cases at the second stage） combined with type II respiratory failure and repeated pulmonary encephalopathy were cured with NPPV treatment additionally. The arterial blood gas indexes and improvement of clinical symptoms were compared before and after NPPV treatment. Results The partial pressure of carbon dioxide and total carbon dioxide in arterial blood of 6 cases were significantly decreased after the NPPV treatment （ P 〈 0.01 ） , and the arterial partial pressure of oxygen and oxygen saturation were increased compared with those before treatment （P 〈 0.01 ）. After NPPV treatment, the pH value basically returned to normal level, the respiratory acidosis was corrected, but the bicarbonate radical level showed no statistical significant difference before and after NPPV treatment （ P 〉 0.05 ）. During the NPPV treatment, cases who cannot tolerate NPPV or failing to detach the assistant respirator were not found. After treatment, the dyspneas disappeared and the consciousness disturbance was not appeared, and the cases had improved conditions and discharged from the hospital successfully. Conclusion NPPV is a safe and effective treatment method in improving the pulmonary ventilation function of silicosis patients combined with respiratory failure especially when the drug therapy is not effective.

关 键 词：无创正压机械通气 矽肺 呼吸衰竭 

分 类 号：R135[医药卫生—劳动卫生]