无创正压通气治疗AECOPD呼吸衰竭并意识障碍的临床观察  

Clinical observation of noninvasive positive pressure ventilation(NIPPV) for acute exacerbation of chronic obstructive pulmonary disease with respiratory failure and disturbance of consciousness

作　　者：龙训辉[1] 王齐国[1] 

机构地区：[1]新疆医科大学附属中医医院重症医学科,新疆乌鲁木齐832000

出　　处：《中国医学装备》2016年第5期106-109,共4页China Medical Equipment

摘　　要：目的:观察无创正压通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)呼吸衰竭并意识障碍的临床疗效。方法:选择58例诊断为AECOPD呼吸衰竭伴意识障碍的患者,随机将其分为无创正压通气(NIPPV)组和对照组,每组29例。对照组给予常规治疗;NIPPV组在常规治疗的基础上,给予NIPPV治疗,观察两组患者治疗前及治疗后24 h及72 h的心率(HR)、呼吸频率(RR)、格拉斯哥昏迷记分(GCS)评分及血气分析,观察两组患者转归情况及NIPPV组不良反应发生情况。结果:血气分析中,NIPPV组动脉血二氧化碳分压(PaCO_2)、RR及HR在治疗后24 h及72 h均明显降低,动脉血氧分压(PaO_2)及GCS评分均明显升高;NIPPV组与对照组比较,24 h及72 h的PaO_2、PaCO_2、HR及GCS评分均存在差异(t=11.29,t=9.19,t=9.21,t=11.23,t=10.30,t=7.28,t=10.34,t=6.69;P<0.05)。NIPPV组的治愈率明显高于对照组,气管插管较率低,差异有统计学意义(x^2=10.07,x^2=8.32,P<0.05);院内病死率低于对照组,差异无统计学意义(x^2=3.50,P>0.05)。NIPPV组部分患者出现初期不适、面部皮肤充血糜烂、轻度消化道不适症状及恐惧心理,经对症处理后均改善。结论:NIPPV治疗AECOPD呼吸衰竭并意识障碍的患者,可有效纠正呼吸性酸中毒及CO_2潴留,效果优于常规治疗。Objective：TTo observe the clinical efficacy of noninvasive positive pressure ventilation（NIPPV）for AECOPD with respiratory failure and disturbance of consciousness.Methods：A total of 58 AECOPD patients with respiratory failure and consciousness in our hospital from 2011 July to August 2015 were randomly divided into NIPPV group and control group. The control group was received conventional therapy, and NIPPV was added to the NIPPV group. The heart rate（HR）, respiratory rate（RR）, Glasgow coma score（GCS） and blood gas analysis of patients before and after 24 h, 72 h of treatment, and the adverse reactions in NIPPV group were observed.Results： The PaCO2, RR, HR at 24 h and 72 h were significantly lower and PaO2 and GCS were significantly increased in NIPPV group. Compared to the control group, PaO2, PaCO2, HR and GCS after 24 h and 72 h were different （t=11.29,t=9.19,t=9.21,t=11.23,t=10.30,t=7.28, t=10.34,t=6.69;P〈0.05） . NIPPV group had a higher cure rate and relatively low rate of endotracheal intubation than the control group. The differences are statistically significant（x2=10.07,x2=8.32,P〈0.05）. The hospital mortality is lower than the control group and there is no statistically significant（x2=3.50,P〉0.05）. Some patients in NIPPV group had initial discomfort, facial skin hyperemia erosion, mild gastrointestinal discomfort and fear, which were improved after symptomatic treatment.Conclusion： NIPPV treatment for AECOPD patients with respiratory failure and disturbance of consciousness which can effectively correct respiratory acidosis and CO2 retention. The spontaneous breathing and arterial oxygen level of patient can be gradually recovered, which are better than the conventional treatment.

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：R563.8[医药卫生—呼吸系统]