无创正压通气NIPPV两种通气模式治疗COPD合并Ⅱ型呼吸衰竭患者的疗效及安全性分析  

Curative Effect and Safety Analysis of two Ventilation Modes of Non-invasive Positive Pressure Ventilation( NIPPV) in the treatment of Patients with COPD and type II Respiratory Failure

作　　者：刘琴[1] LIU Qin(West China Hospital, Sichuan University, Sichuan Chengdu 610041, China)

机构地区：[1]四川大学华西医院呼吸与危重症医学科,四川成都610041

出　　处：《河北医学》2019年第4期668-671,共4页Hebei Medicine

基　　金：四川省科技厅资助项目;(编号:16PJ339)

摘　　要：目的:分析持续气道正压通气(CPAP)和双水平自主呼吸和时间控制通气(ST)模式治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者的疗效及安全性。方法:将我院86例COPD合并Ⅱ型呼吸衰竭患者作为研究对象,按照简单随机分组法分为CPAP组和ST组,各43例,分别予以CPAP模式、双水平ST模式的无创呼吸机治疗,比较两组生命体征指标、血气分析指标、呼吸力学指标[呼吸频率(f)、潮气量(VT)、吸气/呼气周期时间比(Ti/T)]水平和安全性。结果:两组治疗3d时HR、SBP、DBP、PaCO_2、f均降低(P<0.05),SpO_2、PaO_2、pH值、VT、Ti/T均升高(P<0.05),且ST组治疗前与治疗3d的HR差值、SpO_2差值、SBP差值、DBP差值、PaO_2差值、PaCO_2差值、p H值差值、f差值、VT差值均大于CPAP组(P<0.05)。ST组不良反应发生率9.30%与CPAP组的13.95%无显著差异(P>0.05)。结论:ST模式无创呼吸机治疗COPD合并Ⅱ型呼吸衰竭患者效果优于CPAP模式,更能够改善患者生命体征、血气分析和呼吸力学,且未对患者造成明显不良影响。Objective: To analyze the curative effect and safety of continuous positive airway pressure (CPAP) and bi-level spontaneous breathing and time-controlled ventilation (ST) in the treatment of patients with chronic obstructive pulmonary disease (COPD) complicated with type II respiratory failure. Methods: 86 patients with COPD and type II respiratory failure in the hospital were enrolled in the study. According to simple random grouping method, they were divided into CPAP group and ST group, 43 cases in each group. The two groups were treated with non-invasive ventilator of CPAP mode and bi-level ST mode, respectively. The levels and safety of vital signs indexes , blood gas analysis indexes, respiratory mechanics indexes [breathing frequency (f), tidal volume (VT), inspiratory/expiratory cycle time ratio (Ti/T)] in the two groups were compared. Results: After treatment for 3 days, HR, SBP, DBP, PaCO 2 and f in both groups were all decreased (P<0.05), while SpO 2, PaO 2, pH, VT and Ti/T were all increased (P<0.05). The differences in HR, SpO 2, SBP, DBP, PaO 2, PaCO 2, pH, f and VT before and at 3d after treatment of ST group are greater than those of CPAP group (P<0.05). There was no significant difference in the incidence of adverse reactions between the ST group (9.30%) and the CPAP group (13.93%)(P>0.05). Conclusion: The effect of non-invasive ventilator with ST mode is superior to that with CPAP in the treatment of patients with COPD combined with type II respiratory failure, which can more improve the vital signs, blood gas analysis and respiratory mechanics of patients without obvious adverse effects on patients.

关 键 词：无创正压通气 持续气道正压通气 自主呼吸和时间控制通气 慢性阻塞性肺疾病 II型呼吸衰竭 

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