不同压力水平无创正压通气治疗慢性阻塞性肺疾病急性加重期伴Ⅱ型呼吸衰竭的临床效果及其对血气指标的影响

摘要

目的：观察不同压力水平无创正压通气（NIPPV）治疗慢性阻塞性肺疾病急性加重期（AECOPD）伴Ⅱ型呼吸衰竭的临床效果及其对血气指标的影响。方法选取昆山市花桥人民医院2013年2月—2015年2月收治的AECOPD 伴Ⅱ型呼吸衰竭患者90例，按照随机数字表法分为低吸气压力组、舒适吸气压力组和高吸气压力组，每组30例。3组患者均给予常规治疗，并在此基础上行 NIPPV 治疗，模式为压力支持通气（ PSV）＋外源性呼气末正压（PEEPe），低吸气压力组患者呼吸机吸气相气道正压（IPAP）设置为4 cm H2 O，舒适吸气压力组患者呼吸机 IPAP 设置为11 cm H2 O，高吸气压力组患者呼吸机 IPAP 设置为16 cm H2 O。比较3组患者临床疗效、治疗前后血气指标〔动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、血氧饱和度（SaO2）、pH 值〕、住院时间、并发症发生率及病死率。结果3组患者临床疗效比较，差异无统计学意义（ u ＝0.382，P ＝0.826）。治疗前3组患者 PaO2、PaCO2、SaO2、pH 值比较，差异无统计学意义（P ﹥0.05）；治疗后舒适吸气压力组和高吸气压力组患者 PaO2、SaO2及 pH 值高于低吸气压力组，PaCO2低于低吸气压力组，高吸气压力组患者 PaO2、SaO2及 pH 值高于舒适吸气压力组，PaCO2低于舒适吸气压力组（P ﹤0.05）。3组患者住院时间、并发症发生率及病死率比较，差异无统计学意义（ P ﹥0.05）。结论高压力水平（IPAP 为16 cm H2 O）NIPPV 治疗 AECOPD 伴Ⅱ型呼吸衰竭的临床效果较好，能有效改善患者的血气指标，且不增加患者的住院时间、并发症发生率及病死率。%Objective To observe the clinical effect non - invasive positive pressure ventilation( NIPPV) under different stresses on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with type Ⅱ respiratory failure and the impact on blood - gas index. Methods From February 2013 to February 2015,a total of AECOPD patients complicated with type Ⅱ respiratory failure were selected in the People's of Huaqiao Town,Kunshan,and they were divided into A group,B group and C group according to random number table,each of 30 cases. Patients of the three groups received conventional treatment and NIPPV(PSV + PEEPe),the IPAP of A group was 4 cm H2 O,that of B group was 11 cm H2 O,that of C group was 16 cm H2 O. Clinical effect,PaO2 ,PaCO2 ,SaO2 and pH before and after treatment,hospital stays,incidence of complications and fatality rate were compared among the three groups. Results No statistically significant differences of clinical effect was found among the three groups( u = 0. 382,P = 0. 826). No statistically significant differences of PaO2 , PaCO2 ,SaO2 or pH was found among the three groups before treatment(P ﹥ 0. 05);after treatment,PaO2 ,SaO2 and pH of B group and C group were statistically significantly higher than those of A group,while PaCO2 of B group and C group was statistically significantly lower than that of A group,respectively,PaO2 ,SaO2 and pH of C group were statistically significantly higher than those of B group,while PaCO2 of C group was statistically significantly lower than that of B group(P ﹤ 0. 05). No statistically significant differences of hospital stays,incidence of complications or fatality rate was found among the three groups (P ﹥ 0. 05). Conclusion NIPPV under 16 cm H2 O of IPAP has better clinical effect in treating AECOPD complicated with typeⅡ respiratory failure,can effectively improve the blood - gas index without increasing the hospital stays, incidence of complications or fatality rate.