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目的探讨无创正压通气(NPPV)救治慢性阻塞性肺疾病急性发作期(AECOPD)并发Ⅱ型呼吸衰竭及肺性脑病患者的临床疗效。方法将2011年1月至2013年12月住院的56例AECOPD并Ⅱ型呼吸衰竭伴意识障碍患者分为无创通气(NPPV)组24例和有创通气(MV)组32例,两组均进行常规综合治疗,包括抗感染、化痰、雾化吸入支气管扩张剂。NPPV组在常规治疗基础上用无创呼吸机进行NPPV治疗,MV组进行气管插管及有创通气治疗。观察两组患者治疗前后的APPACHE II评分、动脉血气、意识状态情况,同时观察两组动脉血气、血清白蛋白水平、ICU住院时间及呼吸机相关性肺炎(VAP)发生率。结果两组患者治疗前各项指标比较差异无统计学意义(P均>0.05)。两组治疗72 h指标与治疗前比较,APPACHE II评分、GCS评分、p H、Pa CO2、Pa O2、RR、HR差异均有统计学意义(P均<0.05)。NPPV组治疗6 h血气中p H值低于MV组,Pa CO2高于MV组,72h BE低于MV组,差异有统计学意义(P均<0.05);两组治疗72 h与治疗6 h比较,Pa O2、GCS评分、APPACHE II评分差异无统计学意义(P均>0.05)。NPPV组的ICU住院时间短于MV组(P<0.05),VAP发生率低于MV组(8.3%vs 37.5%,P<0.05),两组血清白蛋白水平比较差异无统计学意义(P>0.05)。结论 AECOPD并Ⅱ型呼吸衰竭伴不同程度意识障碍患者应用NPPV有较好疗效,可减少患者ICU住院时间及VAP发生率。
Objective To investigate the clinical efficacy of noninvasive positive pressure ventilation (NPPV) in the treatment of patients with chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure and pulmonary encephalopathy. Methods 56 patients with AECOPD and type Ⅱ respiratory failure and impaired consciousness hospitalized from January 2011 to December 2013 were divided into noninvasive ventilation (NPPV) group (n = 24) and invasive ventilation (MV) group (n = 32) General conventional treatment, including anti-infection, phlegm, inhalation of bronchodilators. The NPPV group was treated with noninvasive ventilator for NPPV on the basis of conventional treatment. The MV group was treated by intubation and invasive ventilation. The APPACHE II score, arterial blood gas and consciousness status before and after treatment were observed. The arterial blood gas, serum albumin, ICU length of hospital stay and the incidence of ventilator-associated pneumonia (VAP) were also observed. Results There was no significant difference between the two groups before treatment (P> 0.05). There was significant difference in APPACHE II score, GCS score, p H, PaCO 2, Pa O 2, RR and HR between the two groups at 72 h after treatment. The p value of blood gas in NPPV group was lower than that in MV group at 6 h, PaCO 2 was higher than that in MV group, and was lower at 72 h BE than that in MV group (all P <0.05) There was no significant difference between Pa O2, GCS and APPACHE II scores (P> 0.05). The hospital stay time of ICU in NPPV group was shorter than that in MV group (P <0.05), and the incidence of VAP was lower than that in MV group (8.3% vs 37.5%, P <0.05). There was no significant difference in serum albumin level between the two groups (P> 0.05). Conclusion AECOPD and type Ⅱ respiratory failure with varying degrees of impairment in patients with NPPV have a good effect, can reduce the ICU length of hospital stay and VAP incidence.