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目的观察双水平气道正压通气(Bi PAP)辅治慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床效果。方法将90倒COPD急性加重伴Ⅱ型呼吸衰竭患者随机分为治疗组和对照组各45例。对照组患者给予常规治疗,治疗组患者在常规治疗的基础上加以Bi PAP呼吸机辅助通气。对比观察2组患者治疗前后的呼吸(RR)、心率(HR)、血气分析指标变化及治疗转归情况。结果 2组T0时RR、HR、p H、Sa O2、Pa O2和Pa CO2水平比较差异无统计学意义(P>0.05)。治疗后治疗组T1、T2、T3时点各指标均显著改善(P<0.05);对照组T1、T2时点改善幅度与治疗前比较差异无统计学意义(P>0.05),T3时点与治疗前比较差异有统计学意义(P<0.05);治疗组T1、T2、T3时点各观察指标水平均显著优于对照组,差异有统计学意义(P<0.05)。治疗组因意识障碍加重7例,二氧化碳潴留未见明显改善转有创通气行气管插管治疗,共40例治疗有效,2例患者死亡;对照组20例行气管插管治疗,29例治疗有效,6例死亡。治疗组治疗有效率高于对照组,气管插管率低于对照组,住院时间短于对照组,差异均有统计学意义(P>0.05)。2组病死率差异无统计学意义(P>0.05)。结论 Bi PAP辅治COPD合并Ⅱ型呼吸衰竭,可加快呼吸功能恢复速度,降低气管插管率,缩短住院时间,值得临床推广应用。
Objective To observe the clinical effect of bi-level positive airway pressure (Bi PAP) on chronic obstructive pulmonary disease (COPD) with type Ⅱ respiratory failure. Methods 90 patients with acute exacerbation of COPD and type Ⅱ respiratory failure were randomly divided into treatment group and control group, 45 cases each. Patients in the control group were given routine treatment, and patients in the treatment group were given Bi PAP ventilator-assisted ventilation on the basis of routine treatment. Compare the two groups of patients before and after treatment of respiration (RR), heart rate (HR), changes in blood gas analysis indicators and treatment outcome. Results There were no significant differences in RR, HR, p H, Sa O2, Pa O2 and Pa CO2 levels between the two groups at T0 (P> 0.05). After treatment, the indexes of T1, T2 and T3 in treatment group were significantly improved (P <0.05), while there was no significant difference between T1 and T2 in control group (P> 0.05) The difference between the two groups was statistically significant (P <0.05). The levels of all the indexes at T1, T2 and T3 in the treatment group were significantly better than those in the control group (P <0.05). Treatment group due to disturbance of consciousness in 7 cases, no significant improvement in carbon dioxide retention and invasive ventilation endotracheal intubation treatment, a total of 40 cases were treated effectively, 2 patients died; control group of 20 tracheal intubation, 29 cases of effective treatment , 6 died. The effective rate of treatment group was higher than that of control group, intubation rate was lower than control group, hospitalization time was shorter than that of control group, the difference was statistically significant (P> 0.05). No significant difference was found between the two groups (P> 0.05). Conclusions Bi PAP can improve the recovery of respiratory function, reduce the rate of tracheal intubation and shorten the length of hospital stay in patients with COPD complicated with type Ⅱ respiratory failure, which deserves clinical application.