BiPAP模式机械通气在慢性呼吸功能不全患者中的应用(1)
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[摘要] 目的 分析慢性呼吸功能衰竭患者采用双水平气道正压通气(BiPAP)模式呼吸支持的临床效果。方法 选择92例慢性呼吸功能衰竭患者，随机分为治疗组及对照组，对照组采用经面罩给氧呼吸支持，治疗组采用BiPAP模式进行无创呼吸支持。比较两组患者治疗期间血气分析参数变化及临床治疗效果。结果 治疗后30min、2h及8h后，治疗组PCO2、HCO3-水平低于对照组(P<0.05)，pH、PO2水平高于对照组(P<0.05)，治疗2h后及8h后，治疗组BE水平低于对照组(P<0.05)，治疗组临床有效率高于对照组(P<0.05)，治疗组患者治疗期间无呼吸机相关急性肺损伤发生。结论 BiPAP模式呼吸支持能够改善慢性呼吸功能衰竭患者的疗效，具有较好的呼吸支持效果。
[关键词] 双水平气道正压通气；呼吸支持；血气分析
[中图分类号] R563.8 [文献标识码] B [文章编号] 1673-9701(2011)36-55-02
Application of Mechanical Ventilation with BiPAP in Patients with Chronic Respiratory Insufficiency
PENG Zhiguo
Emergency Department of Jinhua Central Hospital in Zhejiang Province，Jinhua 321000，China
[Abstract] Objective To analyze clinical effect of ventilation support with BiPAP on patients with chronic respiratory insufficiency(CRI). Methods Ninty-two cases of patinets with CRI were randomly divided into treatment group and control group，ventilation support with face mask inspiring oxygen were taken in control group，and atraumatic ventilation support with BiPAP were taken in treatment group，parameter of blood gas analysis and curative effect were contrasted between control group and treatment group during therapy. Results Levels of PCO2 and HCO3- was lower(P<0.05) and levels of pH and PO2 were higher in treatment group than in control group at 30min，2h and 8h after therapy(P<0.05)；Levels of BE were lower in treatment group than in control group at 2h and 8h after therapy(P<0.05)；Effective rate was higher in treatment group than in control group(P<0.05)，and there was no ventilator associated lung injury in treatment group during therapy. Conclusion Ventilation support with BiPAP could improve curative effect in patients with CRI and has good effect of ventilation support.
[Key words] BiPAP；Ventilation support；Blood gas analysis
慢性呼吸功能衰竭是临床常见的危重症，是终末期肺病、心血管疾病常见的并发症，采用呼吸支持改善患者的乏氧状态是最有效的治疗手段之一，鼻或面罩无创双水平气道正压通气(BiPAP)呼吸支持能够经面罩给氧，无需气管插管建立人工气道，能够减少患者的治疗创伤，在呼吸功能衰竭的临床救治中应用逐渐增多[1]。我科采用BiPAP模式对慢性呼吸功能衰竭患者进行呼吸支持，取得了较好的临床效果，现报道如下。
1 资料与方法
1.1 一般资料
选择我院2007年1月～2010年1月急诊科收治的慢性呼吸功能衰竭患者92例，其中男53例，女39例，年龄18～89岁，平均53.5岁；原发病重症哮喘32例，慢性支气管肺炎急性加重39例，其他疾病21例。根据既往病史、临床症状、胸部X线片以及血气分析确诊，所有患者血气分析PO2均<60mmHg，伴或不伴CO2潴留。将患者随机分为治疗组及对照组各46例，两组患者的一般资料无显著差异，具有可比性 ......
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