摘要
目的探讨早期应用无创通气治疗慢性阻塞性肺疾病(COPD)急性加重合并呼吸衰竭的临床价值。方法将80例符合入选标准的COPD急性加重合并Ⅱ型呼吸衰竭的患者随机分为对照组(38例)和试验组(42例)。对照组采用常规的治疗方法(药物治疗+吸氧);试验组采用常规的治疗方法加无创正压通气。观察治疗前、后的临床指标和动脉血气。结果试验组和对照组治疗前的基础情况、生命体征和血气指标差异无显著性(P>0.05)。治疗后两组患者的呼吸频率(RR)、心室率(HR)、动脉血pH、PaO2、PaCO2和SaO2均较治疗前明显改善(P<0.01)。但与对照组比较,试验组治疗4、24和48h后的pH、PaO2和SaO2上升更明显,PaCO2下降更明显(P<0.01)。试验组和对照组的治疗成功率分别为92.9%和86.8%(P>0.05);平均住院时间分别为(11.0±3.6)d和(15.0±4.3)d(P<0.01);医院感染发生率分别为11.9%和10.5%(P>0.05);治疗无效需要气管插管有创通气者分别为3例(7.1%)和5例(13.2%)(P>0.05)。试验组有34例(81.0%)患者对无创通气有较好的依从性。结论早期应用无创通气治疗COPD急性加重合并呼吸衰竭较仅用常规的药物治疗能更快地缓解患者的临床症状;提高PaO2、SaO2和降低PaCO2;能更好地促进患者病情的恢复,减少住院时间。
[Objective] To evaluate the clinical value of early application of noninvasive ventilation for respiratory failure resulting from acute exacerbations of chronic obstructive pulmonary disease（COPD）. [Methods] 80 patients with acute hypercapnia respiratory failure resulting from COPD exacerbation were randomly divided into control group（38 cases） who received conventional medical therapy and trial group（42 cases） who received conventional medical plus noninvasive ventilation. Clinical outcome and arterial blood gas parameters were observed before and after treatment. [Results] There were not significant differences in chnical characteristics, vital sign and arterial blood gas parameters between the two groups before treatment. After treatment both groups had significant improvement in respiratory rate, heart rate, PH, PaO2, PaCO2 and SaO2 compared with basehne （P 〈0.01）. But improvements in PH, PaO2, PaCO2 and SaO2 in trial group were more rapid and significant than those in control group at 4 h, 24 h and 48 h （P 〈0.01）. For trial group and control group, the survival rate was 92.9% and 86.8% （P 〉0.05）; the average duration of hospitalization was （11.0±3.6） days and （15.0±4.3） days （P 〈0.01）; the incidence rate of nosocomial infections was 11.9% and 10.5%（P 〉0.05） respectively. There were 3 patients in trial group who needed endotracheal intubation and invasive ventilation while 5 patients in control group（P 〉0.05）. In trial group 34（81.0%） patients could tolerate noninvasive ventilation well. [Conclusions] The early use of noninvasive ventilation in COPD patients with exacerbated respiratory failure can rapidly improve clinical symptoms and arterial blood gases, and facilitate recovery from respiratory failure, and decrease the duration of hospitalization compared with conventional medical therapy.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2006年第9期1386-1390,共5页
China Journal of Modern Medicine
关键词
无创通气
慢性阻塞性肺疾病
呼吸衰竭
急性加重
noninvasive ventilation
chronic obstructive pulmonary disease
respiratory failure
