双水平无创正压通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭临床研究

摘要

Objective To investigate the clinical efficacy of bilevel noninvasive positive pressure ventilation (BiPAP) in the treatment of patients with chronic obstructive pulmonary disease (COPD) and type Ⅱ respiratory failure. Methods 58 cases of COPD patients with type Ⅱ respiratory failure selected in the general hospital of Shenyang military region from May 2008 to October 2011 were divided into two groups randomly. 29 cases who received conventional treatment were defined as the control group, and the 29 cases who received conventional treatment combined with BiPAP were defined as the observation group. The clinical indexes were compared between the two groups after 24 h treatment. Results Compared with before treatment, the respiratory frequency, heart rate and arterial carbon dioxide partial pressure (PaCO2) in the control group and the observation group decreased significantly after treatment, while the oxygen saturation(SpO2) and arterial oxygen partial pressure (PaO2) increased significantly after treatment (all P < 0.05). Therefore, the respiratory frequency, heart rate and PaCO2 in the observation group were significantly lower than those in the control group after treatment, while the SpO2 and PaO2 were significantly higher than those in the control group after treatment (all P < 0.05). Moreover, the total effective rate in the observation group was significantly higher than that in the control group (all P < 0.05). Conclusion The BiPAP in the treatment of COPD patients with type Ⅱ respiratory failure can improve the oxygenation function markedly, which not only avoids tracheal intubation, but also reduces the mortality rate and improves the quality of life, so the BiPAP is a safe and effective treatment method.%目的 探讨双水平无创正压通气(BiPAP)治疗慢性阻塞性肺疾病 (COPD)合并Ⅱ型呼吸衰竭的临床疗效.方法 选取沈阳军区总医院2008年5月～2011年10月收治的COPD合并Ⅱ型呼吸衰竭患者58例,随机分为两组,采用常规治疗患者29例为对照组,在常规治疗基础上采用BiPAP治疗患者29例为观察组,比较两组患者治疗24 h后的各项临床指标.结果 治疗后,对照组的呼吸频率、心率、动脉血二氧化碳分压(PaCO2)均明显降低,血氧饱和度(SpO2)、动脉血氧分压(PaO2)均明显升高,与治疗前比较,差异均有统计学意义(均P < 0.05).治疗后,观察组呼吸频率、心率、PaCO2均明显降低,SpO2、PaO2均明显升高,与治疗前比较,差异均有统计学意义(均P < 0.05).治疗后,观察组呼吸频率、心率、PaCO2均明显低于对照组,SpO2、PaO2均明显高于对照组,观察组总有效率明显高于对照组,两组之间比较差异均有统计学意义(均P < 0.05).结论 采用BiPAP治疗COPD合并Ⅱ型呼吸衰竭可以明显改善患者的氧合功能,不仅避免了患者的气管插管,还降低了病死率,提高了生活质量,是一种安全有效的治疗方法.