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目的:观察无创机械通气治疗老年慢性阻塞性肺疾病(Chronic obstructive pulmon-ary disease,COPD)合并呼吸衰竭的临床效果及护理方法。方法:回顾分析我院2011年1月-2012年12月收治的COPD合并呼吸衰竭的老年患者122例,分为观察组与对照组,观察组采用BiPAP Vision呼吸机进行无创机械通气治疗,依据氧合调整EPAP,使脉搏血氧饱和度维持在90%以上,当病情好转,及时降低FiO2,降低呼吸条件。并在通气阶段配合心理护理,管道护理,气道湿化,预防感染等护理措施,使患者保持良好的心态,提高治疗依从性,对患者进及家属讲解该方法的优越性,协助患者取舒适体位。严密监护患者病情发展,加强与患者沟通,消除患者紧张、烦躁心理。定期观察患者意识、呼吸、HR、BP等变化。定时复查血气分析,保持充足的液体入量,及避免误解。对照组给予给予持续低流量吸氧治疗,1-3 L/min,并酌情给予呼吸兴奋剂静脉滴注。观察两组患者生命体征变化,并于治疗前后行动脉血气分析。结果:观察组患者治疗后PaO2、PaCO2较治疗前明显改善,治疗前后比较差异有统计学意义(P<0.01);且上述指标较对照组改善更为明显,组间比较差异有统计学意义(P<0.05)。结论:无创机械通气是治疗老年COPD合并呼吸衰竭的一种安全有效的方法。
Objective: To observe the clinical effect and nursing of noninvasive mechanical ventilation on chronic obstructive pulmonary disease (COPD) complicated with respiratory failure. Methods: A retrospective analysis of 122 cases of elderly patients with COPD and respiratory failure admitted to our hospital from January 2011 to December 2012 were divided into observation group and control group. The observation group was treated with BiPAP Vision ventilator for non-invasive mechanical ventilation. According to oxygen Together with EPAP, the pulse oximetry is maintained at above 90%. When the condition improves, the FiO2 will be lowered and the respiratory condition will be lowered. And in the ventilation phase with psychological care, pipeline care, airway humidification, infection prevention and other nursing measures to enable patients to maintain a good attitude and improve treatment compliance, to explain the superiority of the patient and their families to the method to help patients comfort Body position. Closely monitor the patient’s condition, strengthen communication with patients, eliminate patient tension and irritability. Regular observation of patient awareness, respiration, HR, BP and other changes. Regular review of blood gas analysis, to maintain adequate fluid intake, and to avoid misunderstanding. The control group was given continuous low-flow oxygen therapy, 1-3 L / min, and given intravenous infusion of stimulants of stimulation as appropriate. The changes of vital signs in both groups were observed, and arterial blood gas analysis was performed before and after treatment. Results: PaO2 and PaCO2 in observation group were significantly improved after treatment compared with those before treatment, and the difference was statistically significant before and after treatment (P <0.01). The above indexes were more obvious than those in control group, and there was significant difference between the two groups P <0.05). Conclusion: Noninvasive mechanical ventilation is a safe and effective method for the treatment of elderly COPD with respiratory failure.