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目的观察支气管扩张症合并呼吸衰竭患者应用无创正压机械通气(NPPV)治疗前后各项生理指标的变化,评价其疗效。方法选择2010年1月至2011年12月华北油田公司总医院收治的应用无创正压机械通气治疗的支气管扩张症合并呼吸衰竭患者36例,比较治疗前后患者的心率、呼吸频率(RR)、pH值、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)、辅助呼吸肌评分、呼吸困难分级、第1秒用力呼气容积占预计值百分比(FEV1%pred)、第1秒用力呼气容积/用力肺活量比值(FEV1/FVC)、插管率和病死率。结果经无创正压机械通气治疗后,患者的心率、RR、PaCO2、辅助呼吸肌评分和呼吸困难分级均明显下降,pH值、PaO2、PaO2/FiO2、FEV1%pred、FEV1/FVC均明显上升,与治疗前比较差异具有统计学意义(P<0.05)。2例患者因病情恶化行有创机械通气治疗,插管率5.56%,其中1例患者死亡。结论合理选择应用NPPV可以改善支气管扩张症合并呼吸衰竭患者的肺通气功能。
Objective To observe the changes of physiological indexes in patients with bronchiectasis and respiratory failure before and after noninvasive positive pressure mechanical ventilation (NPPV), and to evaluate their curative effect. Methods From January 2010 to December 2011, 36 patients with bronchiectasis and respiratory failure who underwent noninvasive positive pressure mechanical ventilation were enrolled in the General Hospital of Huabei Oil Field Company. The heart rate, respiratory rate (RR), pH PaCO 2, PaO 2, PaO 2 / FiO 2, Assisted Respiratory Muscle Score, Dyspnea Classification, 1 second forced expiratory volume as a percentage of predicted value ( FEV1% pred), forced expiratory volume 1 / FEV1 / FVC, intubation rate and mortality. Results After noninvasive positive pressure mechanical ventilation, the heart rate, RR, PaCO2, assist breathing muscle score and dyspnea scores of patients were significantly decreased, and the values of PaO2, PaO2 / FiO2, FEV1% pred and FEV1 / Compared with the pre-treatment difference was statistically significant (P <0.05). Two patients were treated with invasive mechanical ventilation because of their deteriorating condition. The intubation rate was 5.56%, of which 1 patient died. Conclusion The rational choice of NPPV can improve pulmonary ventilation in patients with bronchiectasis and respiratory failure.