目的：探讨不同比例间歇无创机械通气与持续无创机械通气治疗Ⅱ型呼吸衰竭的临床效果及安全性。方法选择慢性阻塞性肺疾病急性发作并发Ⅱ型呼吸衰竭的患者94例，随机分为间歇A组32例，间歇B组31例，持续组31例，在常规治疗基础上分别采用3：1间歇无创机械通气、1：1间歇无创机械通气和持续无创机械通气治疗。结果三组治疗6 h、24 h、72 h的pH值、PaO2、PaCO2与治疗前比较差异有统计学意义（P<0.05），治疗24 h、72 h的pH值、PaO2、PaCO2与治疗6 h比较差异有统计学意义（P<0.05），治疗72 h的pH值、PaO2、PaCO2与治疗24 h比较差异有统计学意义（P<0.05）。三组撤机前、撤机后6 h、撤机后12 h的pH值、PaO2、PaCO2比较差异无统计学意义（P>0.05）。间歇A组、间歇B组机械通气时间明显少于持续组（P<0.05），间歇A组、B组胃肠胀气、气管插管、呼吸机相关性肺炎、面部压疮发生率均明显低于持续组（P<0.05）。结论两种间歇比例与持续无创机械通气治疗和撤机效果相似，间歇机械通气可明显缩短机械通气时间、住院时间，减少并发症发生，1：1间歇无创通气方案安全性最佳，可能是较理想的无创机械通气方案。%Objective To discuss the clinical effects and safety of different ratios of intermittent noninvasive mechanical ventilation and continuous noninvasive mechanical ventilation in the treatment of typeIIrespiratory failure. Methods A total of 94 patients with acute attack of chronic obstructive pulmonary disease complicated with type II respiratory fail-ure were selected. They were randomly assigned to intermittent group A of 32 patients, intermittent group B of 31 pa-tients and continuous group of 31 patients. They received 3:1 intermittent noninvasive mechanical ventilation, 1:1 inter-mittent noninvasive mechanical ventilation and continuous intermittent noninvasive mechanical ventilation respectively on the basis of regular treatment. Results The pH value, PaO2 and PaCO2 in the three groups in 6 h, 24 h and 72 h after treatment were all significantly different with those before treatment (P<0.05). The pH value, PaO2 and PaCO2 in 24 h and 72 h after treatment were all significantly different with those in 6 h after the treatment (P<0.05). The pH val-ue, PaO2 and PaCO2 in 72 h after treatment were all significantly different with those in 24 h after the treatment (P<0.05). The pH value, PaO2 and PaCO2 in the three groups before the removal of ventilator, 6 h and 12 h after the removal were not significantly different (P>0.05). Duration of mechanical ventilation in intermittent group A and intermittent group B were both significantly lower than those in the continuous group (P<0.05). Incidences of flatulence, tracheal intubation, ventilator-associated pneumonia and facial pressure sores in intermittent group A and intermittent group B were all sig-nificantly lower than those in the continuous group (P<0.05). Conclusion The two intermittent ratios of noninvasive me-chanical ventilation and continuous noninvasive mechanical ventilation have similar effects as the removal of ventilator. Intermittent mechanical ventilation is able to obviously shorten the duration of mechanical ventilation and hospitaliza-tion time, and lower the incidence of complications. 1:1 intermittent noninvasive ventilation has the optimal safety, which is considered to be the ideal choice of noninvasive mechanical ventilation.
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