无创正压通气治疗COPD并呼吸衰竭临床疗效分析

李萌博 季康 蒋希萌

[摘要] 目的 分析慢性阻塞性肺疾病（COPD）并呼吸衰竭患者行無创正压通气治疗的临床效果。 方法 选择2014年9月～2016年9月期间在我院入院治疗的COPD合并呼吸衰竭患者68例，随机分为对照组和观察组，每组34例。对照组患者给予吸氧、抗感染、祛痰、平喘等常规治疗方案，观察组患者在给予常规治疗的同时增加无创正压机械通气，疗程1周，分析两组患者的心率、呼吸频率、动脉血pH值、PaO2、PaCO2变化，观察疗效。 结果 经治疗，观察组总有效率为94.12%，而对照组总有效率为79.41%，组间比较差异有统计学意义（P<0.05）;两组患者的心率、呼吸频率、动脉血pH值、PaO2、PaCO2均较治疗前改善，与对照组相比，观察组改善更明显（P<0.05）。 结论 无创正压通气对COPD合并呼吸衰竭患者有较好疗效。

[关键词] 慢性阻塞性肺疾病;呼吸衰竭;无创正压通气;临床疗效

[中图分类号] R563.9          [文献标识码] B          [文章编号] 1673-9701（2020）15-0052-04

Analysis on the clinical efficacy of non-invasive positive pressure ventilation in the treatment of COPD complicated with respiratory failure

LI Mengbo   JI Kang   JIANG Ximeng

No.2 Department of Internal Medicine，Beijing Armed Police Corps Hospital，Beijing   100027，China

[Abstract] Objective To analyze the clinical effect of noninvasive positive pressure ventilation in the patients with chronic obstructive pulmonary disease（COPD） complicated with respiratory failure. Methods 68 patients with COPD complicated with respiratory failure who were admitted to our hospital for treatment from September 2014 to September 2016 were selected and randomly divided into the control group and the observation group，with 34 cases in each group. Patients in the control group were given conventional treatments such as oxygen uptake，anti-infection therapy，eliminating phlegm，and relieving asthma. Patients in the observation group were further given noninvasive positive pressure mechanical ventilation apart from the conventional treatment. The course of treatment was one week. The changes in the heart rate，respiratory rate， arterial blood pH value， PaO2 and PaCO2 in both groups of patients were analyzed，and the curative effects were observed. Results After treatment， the total effective rate in the observation group was 94.12%，and the total effective rate in the control group was 79.41%， there was significant difference between the two group（P<0.05）. the heart rate，respiratory rate，arterial blood pH value， PaO2， and PaCO2 in both groups of patients were all improved compared with those before treatment. Compared with the control group，the improvement in the observation group was more significant（P<0.05）. Conclusion Non-invasive positive pressure ventilation is effective for patients with COPD complicated with respiratory failure.

[Key words] Chronic obstructive pulmonary disease（COPD）; Respiratory failure; Noninvasive positive pressure ventilation; Clinical efficacy

慢性阻塞性肺疾病（COPD）是一种常见的呼吸道疾病，以持续性呼吸道症状及气流受限为特征。在我国COPD的总体发病率8.6%，其中20～39岁和40岁以上人群的发病率分别为2.1%和13.7%，是我国导致死亡的第三大病因[1]。COPD发病常与感染、吸烟、环境污染、蛋白酶-抗蛋白酶失衡等相关[2]。常表现为咳嗽、咳痰、喘息等症状，急性发作期可有明显呼吸困难，病情严重者常并发呼吸衰竭。治疗上通常给予氧疗、抗感染、止咳、祛痰、平喘等措施。无创内正压通气（NPPV）是临床救治呼吸衰竭常用的手段[3-4]，是通过口鼻面罩、全脸面罩或鼻罩等无创性气道连接方式为患者提供正压通气辅助。有创机械通气模式因需要行气管插管或气管切开，创伤大，并可引起呼吸机相关性肺炎等多种并发症，患者及家属不易接受，仅用于有生命危险的严重呼吸衰竭患者。……