AECOPD合并Ⅱ型呼吸衰竭经无创正压通气治疗的临床研究

摘要

目的 探讨AECOPD合并Ⅱ型呼吸衰竭经无创正压通气治疗的临床效果.方法 选择2008年1月-2009年8月呼吸内科及ICU的144例住院患者,并随机分为观察组(NIPPV)72例和对照组(非NIPPV)72例.对照组72例采用常规治疗,包括抗感染、解痉平喘、祛痰、纠正水电解质紊乱和酸碱平衡失调、支气管扩张剂、通畅气道,持续低流量吸氧、用呼吸兴奋剂及营养支持等治疗,观察组72例除采用常规治疗外加用无创呼吸机治疗,并比较两组患者的血气分析指标变化(呼吸频率RR、心率HR、pH值、PaO2、PaCO2),住院病程,气管插管率和病死率的指标.结果 观察组72例治疗后血气分析各项指标较治疗前有明显改善,住院病程缩短,气管捕管率为15.28%、病死率8.33%,对照组气管插管率为47.22%、病死率34.72%,两组比较差异有显著性(P<0.05).结论 NIPPV治疗AECOPD合并Ⅱ型呼吸衰竭患者是一种有效的方法,能缓解病人的呼吸肌疲劳,改善氧合,能有效地降低PaCO2、呼吸频率和死亡率.从而避免气管插管,疗效显著.提高PaCO2是治疗AECOPD合并Ⅱ型呼吸衰竭的有效手段.%Objective To investigate the clinical effects of the treatment of non-invasive positive pressure ventilation for AECOPD with type II respiratory failure.Methods 144 cases of hospitalized patients were randomly divided into two groups.who were treatted in the Department of Respiratory Medicine and ICU from January 2008 to August 2009,observation group (NIPPV) with 72 cases and the control group (non-NIPPV) with 72 cases.In the control group,they were dealled with routine treatment, including anti-infection,spasmolysis and anti-asthma,expectorant,correcting water-electrolyte disorders and acid-base balance disorders, bronchodilators, airway smooth.eontinuous flow of oxygen at the end, with respiratory stimulants and nutritional support,treatment.In the observation group,on the basic of conventional treatment,the treatment of non-invasive breathing machine.Compare the blood gas analysis index changes (respiratory rate RR, heart rate, HR, pH value, PaO2, PaCO2, hospitalization duration, the trachea intubation rate and mortality indicators of these two groups.Results In the observation group.compared to the situation before the treatment.the indicators of blood gas analysis has significantly improved,the hospitalization was shorter.intubation rate was 15.28%, mortality was 8.33%;In the control group,the rate of traeheal intubation was 47.22%,and mortality was 34.72%,there was significant difference between these two groups(P<0.05).Conclusions NIPPV treatment for the AECOPD with type II respiratory failure is an effective way to alleviate the patient's respiratory muscle fatigue.to improve oxygenation,and can effectively reduce the PaC02,respiratory rate and mortality,and it also can avoid endotracheal intubation.