摘要
目的探讨无创正压通气(NPPV)对慢性阻塞性肺疾病急性发作期(AECOPD)呼吸衰竭伴意识障碍患者的疗效和安全性。方法选择入住呼吸监护室(RICU)的AECOPD呼吸衰竭[pH值≤7.33,且PaCO2≥55mmHg],PaO2/FiO2≤250mmHg]患者进行NPPV治疗,有明显意识障碍[Glasgow昏迷评分(GCS)<10]者为A组;意识障碍不明显(GCS≥10),且年龄、性别、COPD病程、吸烟指数、既往住院及插管次数与A组相匹配的患者为B组。A、B两组均不具有其他NPPV的禁忌证。结果28个月中共有43例AECOPD患者入住RICU,21例接受NPPV治疗的患者入选,其中符合A组标准11例,符合B组标准10例,A组基础PaCO2显著高于B组[(108±25)mmHg比(75±11)mmHg,P<0.01],而GCS、pH和PaO2/FiO2则明显低于B组[GCS:7.2±1.8比12.1±1.6;pH:7.17±0.06比7.29±0.05;PaO2/FiO2:(169±46)mmHg比(186±38)mmHg;P<0.05或P<0.01]。A组NPPV成功率和住院病死率分别为63.6%(7/11)和18.2%(2/11),B组分别为80.0%(8/10)和10.0%(1/10),差异无统计学意义(P均>0.05)。A组最高支持压力均值较B组高5cmH2O,且NPPV、住ICU和总住院时间也分别较B组长3,3和5d(P<0.05或P<0.01)。NPPV失败患者中,A组4例(气道分泌物过多2例,误吸和低血压各1例),B组2例(均为气道分泌物过多)。结论NPPV对AECOPD呼吸衰竭伴意识障碍患者也有较好的疗效,意识障碍本身可能不是NPPV的禁忌证,但需要更大样本的临床研究。
Objective To evaluate the efficacy and safety of noninvasive positive pressure ventilation （NPPV） in the patients with conscious disturbance due to acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and respiratory failure. Methods A prospective case-control study was conducted in the respiratory intensive care unit （RICU） of Anzhen Hospital over 28 months. Twenty-one of forty three consecutive AECOPD patients requiring NPPV for hypercapnic respiratory failure were assignated into group A （Glasgow coma scale 〈 10, n = 11 ） and group B （ GCS ≥10, n = 10 ） and matched for age, sex, COPD course, tobacco comstunption and previous hospitalization history. Results Compared with group B, group A had a higher level of baseline PaCO2[ （ 108± 25） mm Hg vs （75 ± 11 ） mm Hg, P 〈 0.01 ], lower levels of GCS （7.2 ± 1.8 vs 12.1± 1.6,P 〈 0.01）,arterial pH value （7.17±0.06 vs 7.29± 0.05,P〈 0.01） and PaO2/FiO2[（169 ± 46）mm Hg vs （186 ± 38）mm Hg, P 〈 0.05]. The NPPV success rate and hospital mortality were 63.6% （7/11）and 18.2%（2/11） in group A,which were comparable to those in group B [80.0%（8/10）and 10.0% （1/10）, P〉 0.05]. The patients in group A required higher maximal pressure support of an average of 5 cm 1-120 during NPPV and prolonged NPPV time by 3 days, prolonged ICU stay by 3 days and prolonged hospital stay by 5 days, respectively （ P 〈 0.05 or P 〈 0.01 ）. Four patients in group A failed to respond to NPPV due to excessive airway secretion, aspiration or hemodynamie instability. Two eases in group B failed because of excessive airway secretion. Conclusion AECOPD patients with conscious disturbance can respond well to NPPV and conscious disturbance may be not a contraindication of NPPV.
出处
《中国呼吸与危重监护杂志》
CAS
2006年第5期332-336,共5页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
呼吸衰竭
意识障碍
慢性阻塞性肺疾病
无创正压通气
禁忌证
Respiratory failure
Conscious disturbance
Chronic obstructive pulmonary disease
Noninvasive positive pressure ventilation
Contraindication
