Objective: To explore and discuss the clinical curative effect on intermittent positive pressure breathing therapy of non - invasive ventilator in the treatment for chronic obstructive pulmonary disease (COPD) of elderly patients with complication of acute respiratory failure. Methods: 112 elderly patients who were COPD (all of patients were acute exacerbation period) with complication of acute respiratory failure were divided into control group (60 cases) and observation group (52 cases) as the random number table. A series of basic therapy including routine anti-inflammatory, relieving asthma and expectorant therapy were implemented for all of patient. And the non-invasive ventilator was used to implement non-invasive mechanical breathing therapy. In this therapy, patients of control group were implemented sustaining positive pressure breathing therapy, while patients of observation group were implement intermittent non-invasive positive pressure breathing therapy (1:1). The curative effect, pH value (at 6,24 and 72h), PaO2 (at 6,24 and 72h), PaCO2 (at 6,24 and 72h) and complications between the two methods were compared. Results: There was no significant difference in the general demographic characteristics between the two groups. For patients at 6, 24 and 72 h, the differences of the pH value, PaO2and PaCO2 between pre and post-treatment were significant in observation group (F=5.669, F=6.985, F=7.628, P<0.05) and control group (F=5.311, F=6.892, F=7.958, P<0.05) , respectively. The differences of the pH value, PaO2 and PaCO2 at 6h, 24h and 72h were significant (at 24h, F=6.776, F=7.098, F=7.673. at 72 h, F=7.883, F=6.983, F=7.335, P<0.05),respectively. For two groups, the differences of pH value, PaO2 and PaCO2 at pre-weaning, post-weaning 6h and post-weaning 12h were not significant. While the mechanical ventilation time and mechanical ventilation rate of observation group were significant lower than that of control group (t=3.591, x2=3.052, P<0.05). Besides, the incidences of complications including flatulence, trachea intubation, respiratory and relative pneumonia of observation group were significant lower than that of control group (x2=4.997, P<0.05). Conclusion: The new method can significantly shorten duration of breathing and duration of hospital stays. And its incidence of complication is lower while safety of treatment is relatively higher than that of traditional method.%目的:探讨无创呼吸机采用间歇正压呼吸疗法治疗老年慢性阻塞性肺疾病(COPD)并发急性呼吸衰竭的临床疗效.方法:选取医院呼吸内科收治的112例老年COPD并发急性呼吸衰竭患者,所有患者临床分期均为COPD急性加重期,采用随机数表法将其分为观察组(52例)与对照组(60例),两组患者均接受常规抗炎、平喘和化痰等基础治疗,并应用无创呼吸机进行无创机械通气治疗,其中对照组患者采取持续无创正压通气疗法,观察组患者则采用1:1间歇无创正压呼吸疗法,比较两组患者治疗效果、临床6 h、24 h和72 h时pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)指标变化及并发症发生率情况.结果:两组患者一般人口学特征资料比较差异无统计学意义;两组患者治疗6 h、24 h和72 h时pH值、PaO2和PaCO2指标较治疗前均明显改善,差异有统计学意义,观察组(F=5.669,F=6.985,F=7.628;P<0.05);对照组(F=5.311,F=6.892,F=7.958;P<0.05).并且治疗1 d、3 d时pH值、PaO2和PaCO2指标与治疗6 h时比较差异有统计学意义(24 h时:F=6.776,F=7.098,F=7.673;72 h时:F=7.883,F=6.983,F=7.335;P<0.05);两组患者撤机前、撤机后6 h、撤机后12 h时的pH值、PaO2和PaCO2比较差异无统计学意义.但观察组患者机械通气时间、机械通气率明显低于对照组,两组机械通气时间比较差异有统计学意义(t=3.591,P<0.05);两组机械通气率比较差异有统计学意义(x2=3.052,P<0.05).观察组胃肠胀气、气管插管和呼吸及相关肺炎等并发症发生率明显低于对照组,差异具有统计学意义(x2=4.997,P<0.05).结论:采用无创呼吸机1:1间歇通气疗法可显著缩短患者通气时间、住院时间,并且治疗并发症发生率较低,治疗安全性相对较高.
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