Objective : To evaluate the efficacy of non-invasive positive pressure ventilation in COPD patients with type- Ⅱ respiratory failure, and get some experience to guide clinic practice. Methods: 40 cases of COPD patients with type- Ⅱ respiratory failure were retrospectively analysed. Based on conventional medical therapy, all the cases received non-invasive bi-level positive airway pressure ventilation. The changes of symptoms , arterial blood gas analyses , respiratory rate , heart rate and blood pressure were observed before and after treatment, then the comparisoins of these results were made. Results : In the 40 cases, these were 32 cases acquired obvious symptomatic improvement ( higher level of consciousness ,respiratory rate stepped down ,dyspnea lessened)and got discharge; the other 8 cases deteriorated (5 died, 2 discharged automatically, 1 received tracheal intubation for invasive ventilation). The total efficacy rate was 80％ for these patients, the respiratory rate before and after ventilation were24±4/min and20±4/min, the heart rate were110± 17/min and91±22/min respectively. There were significant difference in both, P＜0. 05. However, blood pressure of these patients before and after ventilation were124± 17/75±11mmHg and120± 17/72±9mmHg, there was no significant difference, ( P＞ 0. 05). The patients' PCO2 before and after the ventilation were76± 20 mmHg and63±l7mmHg respectively, there was a significant difference( P＜0. 05). The PO2 before and after ventioation for those 26 patients whose PO2＞ 60mmHg after received conventional medical therapy were81±24mmHg and 74± 20 mmHg respectively, and for those 14 patients whose PO2＜ 60mmHg after received conventional medical therapy were44±11mmHg and64±19mmHg respectively. The difference was obvious in the latter(P＜0. 05) ,but not in the former(P＞0. 05). During ventilation treatment, the ventilation associated complications included gastric distention occurred in 5 patients, dry mouth in 7 patients, poor tolerated in 2 patients, ventilator-depending in 2 patients. None of 40 patients suffered barotraumas, hospital acquired infection or ventilation associated pneumonia and so on. Conclusion : The application of non-invasive BiPAP ventilation in COPD patients with type- Ⅱ respiratory failure can improve symptoms and the blood gas indices,stabilize vital sign, and has less complications which demonstrate that non-invasive BiPAP ventilation is an effective,well tolerated and safe , convenient approach for those patients.%目的:探讨双水平气道正压通气(BiPAP)治疗慢性阻塞性肺疾病并发II型呼吸衰竭的疗效.方法:在常规药物治疗的基础上,应用无创正压通气(BiPAP)治疗COPD并发II型呼吸衰竭40例,观察并比较治疗前后患者临床状况、生命体征(呼吸频率、心率、血压)及血气分析指标(PO2、PCO2)的变化和通气相关的不良反应等.结果:经机械通气治疗后,有32例临床状况明显改善(神志好转、呼吸频率、明显减慢、呼吸困难减轻);8例治疗无效者病情恶化(5例死亡,2例自动出院,1例改为接受气管插管行有创通气治疗),总有效率80%.通气治疗前、后呼吸频率分别为24±4次/min与20±4次/min,两者有显著性差异(P<0.05);通气治疗前、后心率分别为110±17次/min与91±22次/min,亦有显著性差异(P<0.05);血压治疗前为124±17/75±11mmHg,治疗后为120±17/72±9mmHg,两者无显著性差异(P>0.05).通气前、后患者PCO2水平分别为76±20mmHg与63±17mmHg,两者有显著性差异(P<0.05);通气前经常规治疗缺氧初步改善(PO2>60mmHg)的26例患者中,通气前、后PO2分别为81±24mmHg与74±20mmHg,两者无显著性差异(P>0.05);但在通气前经常规治疗后仍PO2<60mmHg的14例患者中,PO2通气前、后为分别为44±11mmHg与64±19mmHg,治疗前、后比较有显著性差异(P<0.05).不良反应:5例出现不同程度腹胀,7例口干,2例不能耐受面罩,2例出现呼吸机依赖,所有病例均无气压伤、院内感染或呼吸机相关性肺炎等并发症发生.结论:双水平正压通气应用于慢性阻塞性肺病并发II型呼吸衰竭患者,能缓解症状,稳定生命体征,有效改善血气指标.且相关并发症少.
展开▼
