摘要
目的探讨无创正压通气（NIPPV）不同时机应用治疗急性加重期慢性阻塞性肺疾病（AECOPD）的价值和疗效。方法将入选的133例AECOPD患者（7．30≤pH〈7．35、45mmHg〈PaCO2≤65mmHg）随机分为观察（A）组和对照（B）组。A组患者均在常规治疗基础上行NIPPV；B组患者给予常规药物治疗，当符合以下条件时（7．25≤pH〈7．30、65mmHg〈PaCO2≤85mmHg）行NIPPV。分别于入选后0、2h、24h、72h、5d及7d观察生命体征、监测血气分析和血氧饱和度，从而比较两组患者的气体交换情况、上机时间、住院时间及气管插管率等指标的差异。结果A组第2、24、72小时、第5天及第7天较B组PaCO2明显降低（P〈0．01）。A组总的气管插管率较B组明显降低（P〈0．01），上机时间和住院时间明显缩短（P〈0．01）。结论AECOPD早期应用NIPPV可明显改善患者的通气，降低气管插管率和住院时间。当7．30≤pH〈7．35及45mmHg〈PaCO2≤65mmHg时，应用NIPPV见效快、效果好、成功率高，是实施NIPPV的最佳时机。
Objective To investigate the curative effect and value of non - invasive positive pressure ventilation （NIPPV） under different timings in the patients with acute exacerbation chronic obstructive pulmonary disease（AECOPD）. Methods 133 cases with AECOPD （7.30≤pH 〈7.35,45 mm Hg 〈 PaCO2 ≤65 mm Hg） in the study were randomized into therapeutic group（ group A） and control group （ group B ）. Group A received NIPPV besides the routine treatment ; B group received the routine medical care as well as the treatment of NIPPV according to patients ＇ conditions （ 7.25 ≤ pH 〈 7.30, 65 mm Hg 〈 PaCO2 ≤85 mmHg）. Vital signs, blood gas, blood oxygen saturation were recorded at 0, 2, 24, 72 h, 5, 7 d in all the cases from group A and group B. The difference of gas exchange, duration of using respiratory machine, duration of hospital stay, the rate of tracheal intubation were compared at the same time. Results PaCO2 and the rate of tracheal intubation in group A were lower than those in group B at 2, 24, 72 h, 5, 7 d （ all P 〈 0.01 ） ; duration of hospital stay and using respiratory machine were shorter in group A than in group B （ P 〈 0. 01 ）. Conclusion Early application of NIPPV for the patients with AECOPD would be best treatment according to the patients＇ conditions （7. 30 ≤ pH 〈7.35,45 mm Hg 〈 PaCO2 ≤65mm Hg） in order to successfully improve patient＇ s ventilation, and relieve the patient＇ s psychosomatic effect as well.
出处
《中国急救医学》
CAS
CSCD
北大核心
2009年第10期932-935,共4页
Chinese Journal of Critical Care Medicine
