无创正压通气治疗AECOPD合并重度高碳酸血症临床疗效回顾性分析  

Retrospective analysis on clinical efficacy of non-invasive positive pressure ventilation in treatment of AECOPD combined with severe hypercapnia

作　　者：刘文广[1] 姚志红[1] 刘飞宇[1] 洪彦科 李勇[1] 陈斌[1] 喻廷凤[1] 何正兵[1] 

机构地区：[1]湖南省益阳市中心医院呼吸内科,湖南益阳413000

出　　处：《中国现代医生》2016年第13期39-41,共3页China Modern Doctor

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）合并重度高碳酸血症的临床疗效。方法 选择2012年1月~2016年2月期间我科使用无创正压通气治疗107例AECOPD合并重度高碳酸血症患者,观察治疗前和治疗2 h、4 h、24 h、48 h、72 h及治疗结束动脉血气分析、好转率、住院日等。结果 无创正压通气治疗107例AECOPD合并重度高碳酸血症患者,其中85例好转,好转率79.4%,平均住院时间（13.4±3.8）d。经无创正压通气治疗好转患者,治疗2 h、4 h、24 h、48 h、72 h及治疗结束后p H上升、PaCO_2下降、PaO_2上升,与治疗前比较,差异均有统计学意义（P〈0.05）。无创正压通气治疗24 h与48 h PaO_2变化差异无统计学意义（P〉0.05）。结论 AECOPD合并重度高碳酸血症应用无创正压通气有较好疗效,对于那些因各种原因拒绝或无法使用有创机械通气的患者,无创正压通气是一种有效的替代治疗措施。Objective To observe the clinical efficacy of non-invasive positive pressure ventilation（NIPPV） in treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） combined with severe hypercapnia. Methods 107 patients with AECOPD accompanied with severe hypercapnia treated by NIPPV in our department from January 2012 to February 2016 were selected, and items such as arterial blood gas analysis before treatment and at 2 h, 4 h, 24 h, 48 h and 72 h after treatment and before discharge, and improvement rate and hospitalization duration were observed. Results Among the 107 patients with AECOPD accompanied with severe hypercapnia treated by NIPPV, 85 cases were relieved, with an improvement rate of 79.4%, and an average hospital stay of （13.4±3.8） days. With non-invasive posi- tive pressure ventilation treatment, pH increased, PaCO2 decreased, PaO2 increased at 2 h, 4 h, 24 h, 48 h, 72 h and the end after treatment, the difference was statistically significant compared with before treatment （P〈0.05）. There was no significant difference in PaO2 at 24 h and 48 h during non-invasive positive pressure ventilation treatment （P〉0.05）. Conclusion Application of NIPPV in treatment of AECOPD with severe hypercapnia has favorable efficacy which is an effective replacement therapy for patients refusing or unable to use invasive mechanical ventilation.

关 键 词：无创正压通气 慢性阻塞性肺疾病 高碳酸血症 呼吸衰竭 

分 类 号：R563.9[医药卫生—呼吸系统]