目标潮气量无创通气在Ⅱ型呼吸衰竭并心功能不全早期应用探讨  

Analysis of early application of non-invasive positive pressure ventilation in type Ⅱ respiratory failure with heart failure for a target tidal volume

作　　者：马志益[1] 邹欣[1] 翁端丽[1] 苏永华[1] 梁荣章[1] 吴永泉[1] 

机构地区：[1]龙岩市第一医院，福建医科大学附属龙岩第一医院呼吸内科,福建龙岩364000

出　　处：《临床肺科杂志》2016年第2期213-216,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨以潮气量为无创正压通气（non—invasive positive pressure ventilation,NPPV）目标,差异化调节通气参数时在慢性阻塞性肺疾病（简称慢阻肺）合并Ⅱ型呼吸衰竭及左心功能不全中的应用效果。方法收集我院2014年以来慢阻肺同时合并Ⅱ型呼吸衰竭与左心功能不全患者45例,单纯合并Ⅱ型呼吸衰竭患者58例,目标潮气量均定在8~10 ml/kg,短时间内逐步调节吸气压和呼气压,以期尽快达到所需潮气量,密切观察患者生命征,比较NPPV前及治疗后2 h呼吸、心率、血压、动脉血气等。结果 NPPV治疗慢阻肺Ⅱ型呼吸衰竭合并心功能不全效果明显,治疗呼吸衰竭合并心功能不全时,吸气压与呼气压均比治疗单纯Ⅱ型呼吸衰竭时高,两者相差有统计学意义（P〈0.001）。结论 NPPV治疗慢阻肺Ⅱ型呼吸衰竭合并心功能不全患者时,以潮气量为目标,差异化调节通气压力,可获得较好的治疗效果,方法简便易行。Objective To investigate the effect of non-invasive positive pressure ventilation（ NPPV） by adjusting the ventilation parameters differently between chronic obstructive pulmonary disease（ COPD） patients with heart failure and without heart failure for a target tidal volume in advance. Methods The study selected 45 COPD patients complicated with type Ⅱ respiratory failure and heart failure as the group A,and 58 COPD patients with typeⅡ respiratory failure only as the group B. After setting a target tidal volume at 8-10 ml /Kg in advance,the inspiratory and expiratory pressure were adjusted gradually in order to achieve the target tidal volume as soon as possible. Their breathing,heart rate and arterial blood gas analysis were recorded before and 2 hours after the treatment of NIPPV.Results For the group A,NPPV was an effective treatment. The inspiratory and expiratory pressures for them were both significantly higher than those for the group B（ P〈0. 001）. Conclusion It is an easy and effective method that adjusting the ventilation pressure differently for a target tidal volume in the treatment of COPD patients complicated with type II respiratory failure and heart failure by NIPPV.

关 键 词：潮气量 无创正压通气 慢性阻塞性肺疾病 呼吸衰竭 心功能不全 

分 类 号：R563.9[医药卫生—呼吸系统] R563.8[医药卫生—内科学]