无创正压通气治疗慢性阻塞性肺疾病Ⅱ型呼吸衰竭合并急性左心功能不全的临床分析  

Clinical Analysis of Noninvasive Positive Pressure Ventilation for the Treatment of COPD-Associated Type Ⅱ Respiratory Failure and Acute Left Cardiac Insufficiency

作　　者：许林[1] 吴珏[1] 彭妮 王波[1] 黄艳香 杨张奎 王保明 赵秀芬 XU Lin;WU Jue;PENG Ni;WANG Bo;HUANG Yan-xiang;YANG Zhang-kui;WANG Bao-ming;ZHAO Xiu-fen(Fifth Affiliated Hospital of Kunming Medical University/Department of Respiratory Medicine,Honghe Prefecture Central Hospital of Southern Yunnan,Gejiu 661000,China)

机构地区：[1]昆明医科大学第五附属医院/红河州滇南中心医院呼吸内科,云南个旧661000

出　　处：《中国医药指南》2018年第16期15-16,共2页Guide of China Medicine

摘　　要：目的观察无创正压通气(NPPV)对慢性阻塞性肺疾病(COPD)所致Ⅱ型呼吸衰竭合并急性左心功能不全的治疗效果。方法 80例AECOPD合并急性左心功能不全患者分为对照组和治疗组各40例,对照组:吸氧、抗炎、平喘、祛痰、强心、利尿、扩血管等治疗;治疗组在对照组基础上加用双水平气道正压通气(BiPAP)治疗。监测治疗前与治疗后24 h、48 h、7 d时心率、血气中pH、PaO_2、PaCO_2以及临床表现变化情况:呼吸困难、意识状态、肺部音等。治疗前、治疗后7 d时超声心动图测定左室射血分数(LVEF)及血浆N末端脑钠肽原(NT-proBNP)浓度。结果治疗组在治疗后24 h、48 h、7 d时心率、pH、PaO_2、PaCO_2均较对照组明显好转(P<0.05);治疗组7 d时NT-proBNP较对照组明显降低(P<0.05);LVEF值较对照组明显改善(P<0.05)。结论 NPPV治疗AECOPD所致Ⅱ型呼吸衰竭合并急性左心功能不全具有良好疗效。Objective To observe the efficacy of noninvasive positive pressure ventilation（NPPV）for the treatment oftype Ⅱ respiratory failure and acute left cardiac insufficiency associated with chronic obstructive pulmonary disease（COPD）. Methods Eighty patients with AECOPD and acute left cardiac insufficiency were assigned to the control group or treatment group; the control group received oxygen, anti-inflammatory, anti-asthmatic, expectorant, cardiotonic, diuretic, vasodilator and other treatments; the treatment group received bilevel positive airway pressure（Bi PAP） ventilation in addition to the treatment given to the control group. Changes in heart rate, and pH, PaO_2 and PaCO_2 in blood gas analysis, as well as the clinical manifestations including dyspnea, conscious state and pulmonary rales were monitored pre-treatment and at 24 hours, 48 hours and 7 days post-treatment. Left ventricular ejection fraction（LVEF） on echocardiography and plasma N-terminal prohormone of brain natriuretic peptide（NT-proBNP） concentrations were determined pretreatment and at 7 days post-treatment. Results Compared to the control group, there were significantly greater improvements in heart rate, pH, PaO_2 and PaCO_2 from 24 hours, 48 hours and 7 days post-treatment（P〈0.05）, significantly decreased NT-proBNP at 7 days post-treatment（P〈0.05） and significantly improved LVEF at 7 days post-treatment（P〈0.05）, in the treatment group. Conclusion NPPV produced favorable efficacy for the treatment of type II respiratory failure and acute left cardiac insufficiency associated with AECOPD.

关 键 词：无创正压通气 慢性阻塞性肺疾病 呼吸衰竭 急性左心功能不全 

分 类 号：R563.9[医药卫生—呼吸系统]