摘要
目的:观察经面罩无创双水平正压通气与有创通气对慢性阻塞性肺病(COPD)并严重呼吸衰竭患者动脉血气改善的治疗作用。方法:将COPD并严重呼吸衰竭患者分为治疗组和对照组,均给予抗感染、支持等一般常规治疗;在此基础上治疗组加用无创通气治疗,对照组加用有创通气治疗。对所有患者进行血压、血氧饱和度等监测,并分别于治疗0、2～ 3、6、24、72 h、持续通气治疗结束前及结束后2 h动脉血气分析。并严密观察神志、呼吸、心率、血压等在各个治疗时期的变化。结果:共观察患者52例。治疗组29例,其中2例家属要求放弃治疗;2例改为有创通气．1例死亡。其余24例患者无创通气治疗后好转,机械通气治疗时间7．6±5．4 d,精神状态好转时间4．8±3．8(2～22)h,住院时间13．3±5．8 d。对照组23例,其中6例拒绝气管插管而改用无创通气治疗,2例放弃治疗,2例死亡;其余13例好转,好转率与治疗组比无显著置异(P>0．05),意识状态好转时间4．5±2．6(2～11)h(与治疗组比较,P>0．05),通气时间6．5±6．2 d(与治疗组比较, P>0．05),住院时间12．2±8．8 d(与治疗组比较,P>0．05)。动脉血气、心率、呼吸等变化,两组间无显著差异。治疗组面部压伤4例,腹胀5例;对照组4例机械通气6 d后并发肺部感染,腹胀4例。结论:无创通气治疗对于COPD并严重呼吸衰竭患者有较好改善动脉血气的作用,与有创通气疗效相似,而且肺部感染发生等不良情况发生率明显下降。
Objective： We conducted a prospective, randomized trial of BiPAP noninvasive positive-pressure ventilation as compared with endotracheal intuhation or tracheotomy with conventional mechanical ventilation in patients with severe respiratory failure who required mechanical ventilation, and the arterial blood gas value improvement was compared. Methods： According to the arterial-blood gas value, and consciousness determined at baseline, severe patients of COPD with respiratory failure were included. Patients were assigned into treatment group control group, the treatment group were received noninvasive ventilation, and control group were treated with conventional mechanical ventilation. Medical management for the conditions, which consist of anti-infection, and general medical therapy, eet, were similar in the two groups. All patients underwent corn tinuous electrocardiography and monitorirng of arterial oxygen saturation. Arterlal-blood gas value were determined at baseline, at 2-3 hour, at six-hour, 24-hour and 72-hour intervals during mechanical ventilation, and before discontinuation of ventilatory support. Consciousness, breathe, heart rate, blood pressure were observed during the treating period. Results： 52 patients were enrolled in the study 29 in the treatment group ,while 23 in the wound group. In treatment , 2 subjects quit treatment required by his family, 2 subjects switched to endotracheal intubation and convention al ventilatilation , 1 died,, the other 24 subjects recoverd after noninvasive ventilation. The length of ventilation was 7.6 ± 5.4d,the time of consciousness recover was 4. 8 ± 3.8（2-22）hour, the length of stay in the hospital was 13.3 ± 5. 8d. In control group, 6 cases were noninvasive ventilated for refusal of endotracheal intubation, 2 subjects quit treatment, 2 died, 13 subjects recovered after conventional mechanical ventilation. The length of ventilation was 6. 5 ± 6. 2d （ vs treatment group, P〉0. 05）, the time of consciousness recover was 4. 5 ± 2. 6（2-11）hour （ vs treatment group, P〉0. 05）,the duration of stay in the hospital was 12. 2 ± 8. 8d （ vs treatment group, P〉0. 05）. The patients in the two groups had a similar initial change in PaO2 ：FiO2, PaCO2 and heart rate, 4 patients facial-skin breakdown （especially at the bridge of the nose）, 5 cases gastric distention in treatment group. While 4 patients had ventilator-associated pneumonia, 4cases had gastric distention in control group. Conclusion： We found that noninvasive ventila tion was as effective as conventional ventilation, especially in improving gas exchange in patients with sever respiratory failure, and was associated with fewer serious complications that ventilator-associated pneumonia.
出处
《中国临床医学》
北大核心
2006年第2期204-206,共3页
Chinese Journal of Clinical Medicine
关键词
无创正压通气
严重呼吸衰竭
动脉血气
Noninvasive positive-pressure ventilation
Severe respiratory failure
Arterial-blood gas values
