不同压力水平无创正压通气治疗慢性阻塞性肺疾病急性加重期伴Ⅱ型呼吸衰竭的临床效果及其对血气指标的影响  

Clinical Effect Non-invasive Positive Pressure Ventilation under Different Stresses on Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated with Type Ⅱ Respiratory Failure and the Impact on Blood- gas Index

作　　者：陈阳[1] 陈昌荣 韩逸枫 

机构地区：[1]江苏省昆山市花桥人民医院,215300 [2]深圳市宝安区福永人民医院 [3]上海市闵行区江川社区卫生服务中心

出　　处：《实用心脑肺血管病杂志》2015年第11期80-83,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的观察不同压力水平无创正压通气(NIPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)伴Ⅱ型呼吸衰竭的临床效果及其对血气指标的影响。方法选取昆山市花桥人民医院2013年2月—2015年2月收治的AECOPD伴Ⅱ型呼吸衰竭患者90例,按照随机数字表法分为低吸气压力组、舒适吸气压力组和高吸气压力组,每组30例。3组患者均给予常规治疗,并在此基础上行NIPPV治疗,模式为压力支持通气(PSV)+外源性呼气末正压(PEEPe),低吸气压力组患者呼吸机吸气相气道正压(IPAP)设置为4 cm H2O,舒适吸气压力组患者呼吸机IPAP设置为11 cm H2O,高吸气压力组患者呼吸机IPAP设置为16 cm H2O。比较3组患者临床疗效、治疗前后血气指标〔动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、血氧饱和度(Sa O2)、p H值〕、住院时间、并发症发生率及病死率。结果 3组患者临床疗效比较,差异无统计学意义(u=0.382,P=0.826)。治疗前3组患者Pa O2、Pa CO2、Sa O2、p H值比较,差异无统计学意义(P>0.05);治疗后舒适吸气压力组和高吸气压力组患者Pa O2、Sa O2及p H值高于低吸气压力组,Pa CO2低于低吸气压力组,高吸气压力组患者Pa O2、Sa O2及p H值高于舒适吸气压力组,Pa CO2低于舒适吸气压力组(P<0.05)。3组患者住院时间、并发症发生率及病死率比较,差异无统计学意义(P>0.05)。结论高压力水平(IPAP为16 cm H2O)NIPPV治疗AECOPD伴Ⅱ型呼吸衰竭的临床效果较好,能有效改善患者的血气指标,且不增加患者的住院时间、并发症发生率及病死率。Objective To observe the clinical effect non- invasive positive pressure ventilation（ NIPPV） under different stresses on acute exacerbation of chronic obstructive pulmonary disease（ AECOPD） complicated with type Ⅱ respiratory failure and the impact on blood- gas index. Methods From February 2013 to February 2015, a total of AECOPD patients complicated with type Ⅱ respiratory failure were selected in the People＇s of Huaqiao Town,Kunshan,and they were divided into A group,B group and C group according to random number table, each of 30 cases. Patients of the three groups received conventional treatment and NIPPV（ PSV ＋ PEEPe）,the IPAP of A group was 4 cm H2 O,that of B group was 11 cm H2 O,that of C group was 16 cm H2 O. Clinical effect,Pa O2,Pa CO2,Sa O2 and p H before and after treatment,hospital stays,incidence of complications and fatality rate were compared among the three groups. Results No statistically significant differences of clinical effect was found among the three groups（ u = 0. 382, P = 0. 826）. No statistically significant differences of Pa O2,Pa CO2,Sa O2 or p H was found among the three groups before treatment（ P 〉0. 05）; after treatment,Pa O2,Sa O2 and p H of B group and C group were statistically significantly higher than those of A group, while Pa CO2 of B group and C group was statistically significantly lower than that of A group,respectively,Pa O2,Sa O2 and p H of C group were statistically significantly higher than those of B group,while Pa CO2 of C group was statistically significantly lower than that of B group（ P 〈0. 05）. No statistically significant differences of hospital stays,incidence of complications or fatality rate was found among the three groups（ P 〉0. 05）. Conclusion NIPPV under 16 cm H2 O of IPAP has better clinical effect in treating AECOPD complicated with typeⅡ respiratory failure, can effectively improve the blood- gas index without increasing the hospital stays, incidence of complications or fatality rate.

关 键 词：肺疾病 慢性阻塞性 呼吸功能不全 无创正压通气 血气分析 

分 类 号：R563.9[医药卫生—呼吸系统]