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目的探讨无创通气在慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭的临床应用时机。方法将2005年1月至2007年12月北京大学第三医院呼吸科住院的AECOPD合并呼吸衰竭的131例患者分为常规治疗组和常规治疗+无创正压通气(NIPPV)治疗组,再根据治疗前血气值将NIPPV组分为PaCO2≥9.31kPa、7.98～9.31kPa、6.65～<7.98kPa3组,观察其治疗前、治疗后2h、24h、72h的动脉血气分析变化,观察住院天数、气管插管率、病死率。结果两组比较NIPPV组治疗后2hPaO2较对照组明显升高,后期插管率(7.4%)、住院病死率(8.8%)均显著低于对照组(19.0%,22.2%),差异有统计学意义。NIPPV组各亚组比较,PaCO27.98～9.31kPa组与PaCO2≥9.31kPa组比较,前者治疗后2hpH、PaO2、PaCO2有明显改善(P<0.05),与PaCO26.65～7.98kPa组比较,前者治疗后2hPaO2有明显改善(P<0.05),住院天数较其他两组缩短,与PaCO26.65～7.98kPa组比较差异有统计学意义,但病死率及插管率未见下降。结论NIPPV治疗AECOPD合并呼吸衰竭疗效确切,在PaCO27.98～9.31kPa范围内应用无创通气效果好,不会延误治疗效果。
Objective To explore the clinical application of noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure. Methods A total of 131 patients with AECOPD and respiratory failure who were hospitalized in Department of Respiratory Medicine, Peking University Third Hospital from January 2005 to December 2007 were divided into two groups: conventional treatment group and non-invasive positive pressure ventilation (NIPPV) group. According to the treatment Pre-blood gas values of the NIPPV group PaCO2 ≥ 9.31kPa, 7.98 ~ 9.31kPa, 6.65 ~ <7.98kPa3 group were observed before and after treatment 2h, 24h, 72h arterial blood gas analysis changes were observed length of stay, endotracheal intubation Rate, fatality rate. Results Compared with the control group, the 2hPaO2 in the NIPPV group was significantly higher than that in the control group (7.4%) and the in-hospital mortality rate (8.8%) was significantly lower than that of the control group (19.0%, 22.2% significance. Compared with PaCO2≥9.31kPa group in PaCO27.98 ~ 9.31kPa group, 2hpH, PaO2 and PaCO2 in the former group were significantly improved (P <0.05), compared with PaCO26.65 ~ 7.98kPa group in the NIPPV group, PaO2 was significantly improved at 2h after treatment (P <0.05). The days of hospitalization were shortened compared with those of the other two groups. There was significant difference between PaCO26.65 ~ 7.98kPa group, but the mortality and intubation rate did not decrease. Conclusion NIPPV treatment of AECOPD combined respiratory failure curative effect is accurate, the application of non-invasive ventilation in the range of PaCO27.98 ~ 9.31kPa good effect, will not delay the treatment effect.