摘要
目的观察双水平正压通气(Bi-PAP)在拒绝插管(Do-not-intubate)的老年慢性阻塞性肺病急性加重(AECOPD)呼吸衰竭病人的疗效.方法 2006年9月至2010年12月65名入住重症监护病房的老年慢性阻塞性肺病急性加重呼吸衰竭病人纳入研究.将病人随机分为普通治疗组(n=32)和Bi-PAP(n=33)组.比较2组病人研究期间的意识变化、生理学参数的变化、院内死亡率及不良事件发生率.结果老年慢性阻塞性肺病急性加重呼吸衰竭无创通气组与普通治疗组的基线特征一致.经过2 h的治疗,与普通治疗组比较,Bi-PAP组病人的GCS评分有所改善(P<0.01),氧合指数有所改善[182(77～384)vs 165(70～358),P<0.01],PCO2分压有明显下降[55(31～86)mmHg vs 82(47～107)mmHg,P<0.01],院内死亡率较低[11(33%)vs 24(75%),P<0.01],未见不良事件增多.结论 Bi-PAP应用于拒绝插管的老年慢性阻塞性肺病急性加重呼吸衰竭病人不仅可以改善病人的生理学指标,而且可以改善病人的预后.
Objective To determine the effect of bi-level positive airway pressure ventilation(Bi-PAP)in elderly do-not-intubate patients with acute exacerbation chronic obstructive pulmonary disease(AECOPD) and respiratory failure.Methods 65 elderly patients who were admitted to intensive care unit from September 2006 to December 2010 with acute exacerbation chronic obstructive pulmonary disease(AECOPD)and respiratory failure were randomly divided into 2 groups:standard group(n=32) and Bi-PAP group(n=33).The changes of consciousness,physiological parameters,hospital mortality and adverse events in patients were compared between the two groups.Results The baseline characters of patients were similar in both the Bi-PAP and standard therapy groups.After 2 hour of treatment,GCS scores of patients in Bi-PAP group(P<0.01) and median(5th-95th percentile)PaO2/FIO2 ratios were significantly higher[182(77～384) vs 165(70～358),P<0.01],and PaCO2 was lower than standard group[55(31～86)mmHg vs 82(47～107)mmHg,P<0.01].Treatment with Bi-PAP successfully reduced the hospital mortality [11(33%)vs 24(75%),P<0.01].It looked similar with adverse events occurred both Bi-PAP and standard treatment.Conclusion For elderly do-not-intubate patients with AECOPD and respiratory failure,treatment with Bi-PAP not only can improve the patient's physiological parameters,but also improve the patient's outcomes.
出处
《昆明医科大学学报》
CAS
2012年第4期106-109,共4页
Journal of Kunming Medical University
关键词
急性呼吸衰竭
双水平正压通气
无创通气
Acute respiratory failure
Bi-level positive airway pressure
Noninvasive mechanical ventilation
