BiPAP呼吸机治疗COPD合并Ⅱ型呼衰竭的临床研究(1)
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【摘要】目的:探讨鼻(面)罩双水平无创正压通气对COPD合并Ⅱ型呼衰竭患者的治疗效果。方法 100例COPD合并Ⅱ型呼衰竭患者分为两组，对照组50例，实验组50例在常规吸氧、抗炎、解痉平喘，同时给予BiPAP呼吸机通气治疗，评价两组治疗前后患者动脉血气分析指标及临床情况变化。结果 通过对照实验，实验组患者血气分析结果明显优于对照组，住院天数明显低于对照组，差异有统计学意义(P<0.05)。结论BiPAP呼吸机辅助通气治疗COPD合并Ⅱ型呼吸功能衰竭具有肯定的疗效，使得患者提高PaO2，降低PaCO2，促进病员病情恢复，减少住院天数。
【关键词】BiPAP呼吸机;慢性阻塞性肺疾病;呼吸衰竭
【Abstract】Objective To evaluate the clinical efficacy of non - invasive mechanical ventilation with oral-nasal mask on chronic obstructive pulmonary disease(COPD)combined with respiratory failure type Ⅱ by bi - positive airway pressure (BiPAP) breathing machine. Methods 100 patients who suffered from COPD combined with respiratory failure type Ⅱwere enrolled and divided into treatment group(50 cases)and control group( 50 cases). Routine pharmaceutical intervention was adopted in both groups while invasive mechanical ventilation by BiPAP breathing machine was given in the patients of treatment group. Arterial blood gas(ABG)andclinical features were investigated. Results Patients well tolerated with BiPAP breathing machine, arterial partial pressure of oxygen and carbon dioxide were significantly improved after treatment. Comparing with control group, blood gas improvement were earlier and better and the duration of hosipital stay was shorter. (P 〈 0.05 ). Conclusion BiPAP was efficient and safe on COPD combined with respiratory failure type Ⅱ.It could gradually increas PO2 and significantly declin PaCO2 and shorten the duration of hosipital stay. Patients preferablelyrecovery.
【Key words】 BiPAP breathing machine; Chronic obstructive pulmonary disease; Respiratory failure
【中图分类号】R352 【文献标识码】A 【文章编号】1005-0515(2011)07-0264-01
慢性阻塞性肺病(COPD)是临床上常见的呼吸系统疾病，常因感染反复并发Ⅱ型呼吸衰竭，以往多使用气管插管或气管切开后有创呼吸机治疗，技术难度大，大部分病人不能接受，并且容易产生气压伤，医疗费用高，撤机困难，病死率高[1]。BiPAP呼吸机是通过鼻(面)罩采用双水平气道正压，产生较高吸气压(IPAP)帮助病人克服吸气时的气道阻力，从而减轻呼气肌做功和氧耗；在病人呼气时给予较低呼气压力(EPAP)，以对抗内源性呼气末正压，起到扩张终末支气管的作用，促进了氧的弥散和二氧化碳排出，对改善动脉血氧分压和二氧化碳分压、纠正呼吸衰竭起到良好作用[2]。是一种简单的无创通气技术,近些年逐渐发展成熟推广为治疗COPD的有效方法之一。现对2009年至2010年我院采用BiPAP呼吸机治疗COPD100例患者取得较好疗效，现报道如下：
1 资料与方法
1.1一般资料:选择2009至2010年在我院呼吸内科收治的COPD合并Ⅱ型呼衰竭患者，均符合中华医学会呼吸病分会制定的COPD诊断标准，并且这些病人在治疗前排除自主呼吸微弱，肺大泡，气胸，肺栓塞，严重心律失常，心功能不全，低血压休克，上消化道出血 ......
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